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A QUARTERLY JOURNAL 

Scientific, Clinical and Forensic 

Psychiatry and Neurology. 

Intended especially to siibserue t'ne wants of the 
Q-ensrcd (Practitioner of Jledicine. 



VOLUME XVIII. 



C. H. HUGHES. M. D.. 

And an associate corps of collaborators. 



DAVID S. BOOTH, M. D., 



ST. LOUIS: 
Press of Hughes ©• Company. 

1897. 



DigiLizedbyGoOglc 



CONTRIBUTORS AND COLLABORATORS. 

VOLUME XVIII. 



HARRIET C. B. ALEXANDER, 
Chicago. 

MARTIN W. BARR, 

Elwyn, Pa. 
SIR FREDERICK BATEMAN, 

England. 
CLARK BELL, Esq., 

New York. 
DAVID S. BOOTH, 

St. Louis. 

SUSANNA P. BOYLE, 

Toronto, Canada, 
SANGER BROWN, 



Chicago. 



W. S. CHRISTOPHER, 



S. V. CLEVENGER, 



F. X. DERCUM, 



F. GENEKALI, 



ARRIGO GIANNONE, 



WlLLIAIVl LEE HOWARD, 

Baltimore. 
C. H. HUGHES, 



JAS. G. KIERNAN, 

Chicago. 
BEVERLEY O. KINNEAR, 

New York. 
WILLIAM C. KRAUSS. 

Buffalo. 
SYDNEY KUH, 

Chicago. 
HAROLD N. MOVER, 

Chicago. 
JOHN PUNTON, 

Kansas City. 
J. H. WALLACE RHEIN, 

Philadelphia. 
HALDOR SNe've', 

St. Paul. 

J. SOURY, 



France. 



H. P. STEARNS, 



C. C. HERSMAN, 



Pittsburg. 



ALEX. L. HODGDON, 



EUGENIO TANZl, 



J. NELSON TEETER, 

Utica, N. Y. 



G. VASSALE, 



C- «•.' 



D,j.,.db,Googlc 



INDEX TO VOLUME XVlll. 



ORIGINAL CONTRIBUTIONS. 



I tbe 

10 

Cyclone Neuroses 52 

Defense of Modern Psychiatry 48 

Encephalitic and Late Epilepsy 168 

Hygiene of Degeneracy 359 

Imperative Conceptions 43 

insane Confessions 560 

Insane Hereditary. Insane and Con- 
Sanguine Marriages. Etc... 1 

interaction of Somatic and Psychic 

Disorder 28 



Neurastiienia ., 491 

Nearastlienla Essentiails and Neuras- 
thenia Symptomatica 465 

Neurological Progress in America 263 

On intemperance, Con-Sanguine Mar- 
riages, and Educational Over- 
Pressure, as Factors in the Gene- 
sis of Nerve Disease and Degen- 
eration ol the Race 122 

On the Effects of Extirpation of the 

Parathyroid Gisnds.„ _ 57 

Preputial Reflex Epileptiform Convul- 
sions, with Report of a Case 119 

President's Annual Address 477 

Psychical Hermaphroditism. A Few 
Notes on Sexual Perversion, with 
Two Clinical Cases ol Sexual In- 
version Ill 



Psychoses ol Old Age 180 

Report of a Case of Brain Syphilis He- 
roically Treated with Mercury, 
Followed by a Mercurial Neuritis 

and Recovery 22 

Suicide 502 

Syphilis of the Central Nervous Sys- 
tem 510 

The Action of the Nervous System over 
the Nutritive Processes, in Health 
and Disease 538 

The Auto-Toxic Origin of Epilepsy 203 

The Case of Sturgeon Young, A Ques- 
tion of Hypnotic Injury and Death 153 

The Civic Duties and Responsibilities 
of the Physician to his Community, 
State and Nation .'. 404 

Tic Convulsil Replacing Supra-Orbital 

Neuralgia 397 

The Limits of Psychology ..„ 340 

The Medlco-Legai Aspect ol Eroto- 

Choretc Insanities 414 

The Occipital Lobe and Mental Vision.. 399 
The Significance ol "Degeneration" to 

the General Practitioner 54? 

The Stigmata of Degeneration 62 

what is Meningitis? 132 

Tremor and Tremor- 1 ike Movements 

in Chorea 496 



237251 



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Index, 
SELECTIONS. 



Neuro-therapy— 
A Case of Cerebro-Splral Menlneitls 

Complicating Gonorrhoea Treated 

by AntikamnU 216 

Are You In Puln? 576 

Antikamnia and the Neuroses 67 

Auto-lntoxicatlon and Fig Synip„ 68 

Consciousness In Epilepsy 213 

Division of the Cervical Sympathetic 

in Cases of Exophthalmic Goitre... 67 
Eltet of the X-Ray on the Central 

Nervous System 212 

Hyoscyamlne for Paralysis Agltans 419 

In]ectlons of Osmic Add for Neuralgia 214 

Insomnia. „ 68 

Intesttoat Antiseptics In Insanity 213 

In What Cases of Insanity is Thyroid 

Extract U»ful7 419 

NeuropaHiic Heart 214 

Saline Subcutaneous Transfusion In the 

insane _ 214 

Tabes DOTsalls„ 67 

The Antl-rt)eumatic Action of Salicylate 

of Strontium. 69 

The Fleschig Method and Hydrocyanldes 

In Epilepsy „ 576 

Therapeutic Value of Mercury and Ar- 
senic 215 

The Treatment of Atony of the Small 

Intestlna in Neurasthenics 212 

Thyroid Extract in Menopause Mental 

Disorder..- 579 

Thyroid Gland In insanity 577 

Unusual Efforts of the Bromides 67 



PSYCHIATRY— 

Bed Treatment of M elan (holla... 581 

Committee on Diseases of the Mind 

and Nervous Diseases 424 

Etiology of General Paralysis of the 

Insane 580 

Malingering by an Jnsane Hypochon- 
driac 582 

Mental Therapeutics „ 69 

l>leuropattilc Heredity and Alcoholism, 

and Vict i^tna , _ 216 

Prevention of Insanity: The Duty of 

Psychiatry and the State 226 

Specific Treatment for Active Forms of 

Insanity 582 

Steps Toward Insanity 579 

Sypliilltic Melancholia 423 

The Case of Spur^eon Young — Death 

Due to Hypnotism by Unskilled 

Amateurs 421 

NEUI*0-SURGERY-:- 

Some General Principles that should 
Govern Operations for Otitic Brain 
Disease 534 

Surgery in Exophthalmic Goitre 585 

CLINICAL PSYCHIATRY— 

A Case of Cerebral Abscess Situated at 
the Posterior Part of the External 
Capsule 71 

Another Idiot Savant 73 

Communicated Insanity 70 

The Relations of Alcoholism to Insanity 69 



jdbyGoOglC 



PSYCHO- THERAPY— 

Early Treatment of the Insane 73 

Daager ot Home Detention of the Insane 227 
Hyoscin HydrobroniD In the Treatnent 
of Insanity 74 

Clinical Neurology— 
A Case Showing the Nature of Perfor- 
ating Necrosis of the Spinal Cord.. 78 

Aetiologies of Epilepsy 594 

An Enonnous Dose wltbout Death 80 

Apbasla In Polyglots 78 

Birth-Palsy 43X 

Brain Tolerance to Traumatfsai 7G 

Cardiac Neurosis of Sexual Origin 588 

Classification of Epilepsy 7S 

Cboked Disc and Pn^noels 597 

CoDstipatton in the Insane 432 

Eootion Dyspepsia 430 

EtMogy of Graves' Disease 589 

Fissure of Rolando 592 

Hereditary Hydrocephalus 5^2 

Hysteria: A Favorable Prognosis Not 

Always Safe 228 

Hysteria and Epilepsy 596 

Hysteric P(BSls 591 

Increase of Insanity and Consumption 

Among the Negro Population of 

the South Since the War. 428 

fnauencs of Tobacco on the Nervous 

System 587 

lodothyrine In Myxoedema and Goitre 593 

Kerosene In Alcoholism... 228 

Mental Fatieue and Eiercise 77 



Mental State of the Ni^rsp tai H*»ltl| 

of the Nursling HQ 

NeurKstheola _. — 424 

Nenrasthenla and General Nutrition.... 431 
Partial Rupture of the Spinal Cord 

without Fracture oi the Spine 586 

Pseudo-spastic Paresis with .Tremor 

after Trauma 586 

Stigmata of Degeneration 76 

TtctUe Amnesia 589 

The Genitalia and General NutrlthHi.- 590 
The t4ervotis Manifestations of SyphHis 587 
The Symptomatology and Patiiology of 

Exophthalmic Goitre 79 

Thymus Gland In Exophthalmic Goitre 593 

Tic Doloroux 590 

Weather Neuroses 77 

Untoward Effects of Trlonal _ 432 

NEIJ RO-DI AONOSIS— 

Hysteria Diagnosis 440 

Roentgen Ray Locates Bullets Through 

the SltuU. 81 

NEURO-PHYSIOLOGY- 

Heart and Thyroid Innervation 599 

loAuencc of the Vagus on the Secfatlon 

the Urine 81 

Tte So-Called Convulsion Cantre and 
Centre for Locomotion In the Re- 
gion of the Pons 597 

NEURONYMY- 

Neuronymic Progress In America 439 



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NEURO-PATHOLOOY— f 

Epilepsy— Autopsy 433 

Neurasthenia as a Toxic Neurosis 231 

Pathogenesis of Syringomyelia 601 

Pathology ol Buibo-Spinai Atropho- 

Spastlc Paralyses 437 

The Pathology of Aphasia 434 

Trauma, Tabes and Multiple Sclerosis.. 600 



NEURIATRV— 

Nervous Functions of the Suprarenal 



The Pupils in Paresis 229 

The Traumatic Neuroses In their Medi- 
co-Legal Relations 228 



EDITORIALS. 



A Big Meeting _ 444 

According to Holy Writ 94 

A Critique on a Crooked Idea 605 



90 



251 

American Public Health Association 246 

Among the Neurological Treatises 92 

Aphasia Med I CO- Legally Considered... 239 

A Physician in the Cabinet 98 

Asexualization for Crime 447 

Association of Assistant Physicians of 

Hospitals for the insane 249 

Atrophlne Versus Quinine Tinnitus.. 250 

A Study In Morbid Egoism. 240 

A Tough Citizen 91 

Bl-Lateral Psychomotor Myosynchrony 245 

Change of Address 240 

Change of Name 92 

Charles VI 247 

Congres International de Medecine 251 

Des Attitudes Anormales, Spontanees 
Du F^voqu^es, Dans te Tabes 
Dorsal Sans Arthropathies 95 



Dr. Frank Parsons Norbury 84 

Dr. Frank Wilfred Page 100 

Dr. John B. Hamilton 89 

Dr. John H. Callender 91 

Dr. P. «. Wise 89 

Dr. P.O. Hooper Re-Elected 85 

Dr. William F. Drewry 100 

Duchenne and Neurology 610 

Female Escort for insane Women 249 

Gayety and Gloom. 246 

Gimlette 448 

Hereditary Neuropathy and Crime 91 

Higher Medical Education. 232 

Hobart A. Hare 238 

Illinois Eastern Hospital for Insane 247 

International Medical Congress..* 250 

Kleptomania and the Case ot Mrs. 

Castle : 236 

Years In 



Medico-Legal Society 

Medico-Psychological Association... 



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The American Journal of Insanity 444 



Mfraic Locomotor Ataxias 89 

Mississippi Valley Medical Association 448 
Modern Greek as the Language of 

Science 84 

National Contederation of State Med- 
ical Examining and Licensing 

Boards 238 

Neuriatry and Psychiatry 87 

New Pathological Department 238 

Notice to Subscribers and News Agents 95 

Our Mutual Interests 83 

Over the Hookah 92 

Physical Rest Versus Gymnastics after 
Study 



247 

Poetic Therapy 245 

Program of the Section on Neurology 
and Medical Jurisprudence oi the 

American Medical Association 233 

Psychiatry and Neurology at Moscow 611 

Psychalia or Mentalia 603 

Schlatter Dead 445 

Section on Neurology and Medical Jur* 

tsprudence 442 

Selected Good Advice.... 451 

Southern Surgical and Gynecological 

Association.. 102 

Tennessee Centennial and International 
Exposition, Nashville, Tenn 247 



To Castrate the Crippled in Mind 451 

The Change In the Presidency of the 
Stale Commission in Lunacy 96 

The First Medical Degree in New Eng- 
land 610 

The Foreign Cult in American Medi- 



The Functions of the Neuron 93 

The Loud Bill 90 



Teach Medical History 94 

The Medical Staff of the Illinois Hos- 
pital for Insane 247 

The Mfdico-Legal Journal 99 

The Philadelphia Neurological Society 445 
The Physician as a Citizen 248 



The Physicians of Santa Clara County, 

Cal 

The Relationship of Pedology to Neu- 
rology 

Therapeutic Skepticism _ & 

The Rights of the Insane in State Hos- 
pitals 2 

The Second Pan-American Medical 
Congress 



95 



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Tlie Training School for Nurses 444 

The Tme Crtlert* of [nsanlty 86 

the UnrelUblKty of Borax 92 

The Value of a Knowledge of Neurology 100 
To the Members of the Medical Profes- 



sion 

Toxic Neuriatry.... 



.. 248 



Tri-State Medical Society 237 

!. 4S2 

Typhoidous States 235 

University for tfie State of Missouri.... 249 

We AcknowtedEe an Invitation „ 445 

WlUian W. Ireland's Early Honors. 445 



105 

About Children 626 

Architecture of the Brain, Illustrated 104 

A Treatise on Appendicitis 105 

Clinical Lessons on Nervous Diseases.. 258 

Clouston on Mental Diseases 257 

Cdntrarc GeschlechtsgeftichK Sexual In- 
version) 104 

Diseases ot the Ear, Nose and Throat 

and their Accessory Cavities 258 

Disorders About Children 626 

Eye Strain fn Health and Disease 458 

Genius and Degeneration 104 

Hysteria and Certain Allied conditions 455 
La Noavelle Iconocraphle de la Salpi- 
triire entre dans an dtxftne aimie 

d'exjstence 256 

Manual of Medical Jurisprudence 625 



Manual of Static Electricity in X-Ray 

and Therapeutic Uses 256 

Merrelt's DIeest of Materia Medica and 

Pharmacy . . 257 

Neural Terms, international and Na- 
tional 460 

Over tlie ffookah; the Tales of a Talk- ' ; 

atlve Doctor 103 

Physician's Visiting List 105 

Sajous' Annual 626 

Sexual Disorders of Male and Female.. 621 

Text-Book of Mental Diseases 459 

TTw July Monist 459 

The Uading Article 255 



Tba Meaopause... 



. 4«0 



The Non-Heredity of Inebriety )03 



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THE 

Alienist and Neurologist. 

VOL. xviii. ST. LOUIS, January. 1897. No. .1 



ORIGINAL CONTRIBUTIONS. 



INSANE HEREDITY. INSANE AND CON- 
SANGUINE MARRIAGES, ETC.* 



By H. P. STEARNS, 

Supcrlntcndcnl ol Die HartCord Rclreal Ibr the Insanf. Hinford, Conn, 

THERE have been eighty-seven admissions during the 
past year. Seven of these were of persons who had 
formerly been in the Retreat. On examination I find that 
twenty-eight of these eighty-seven persons were reported 
to have had some relative who had been insane; that is 
thirty-five per cent, of the whole number. In seel<ing for 
information in relation to heredity relating to insanity 1 
have examined the records of 870 persons, all of them ad- 
mitted to the Retreat during the last ten years. Of these 
193 were known to have had an inheritance' of insanity, 
either direct or indirect, i have thought it might be of in- 

■RcportlolhcBoanlolDlrtctars. April, 1S96, 

(11 



,db,G()ogle 



H. P. Steams. 



terest to exhibit by means of a table in what form and de- 
gree this heredity appeared, and herewith subjoin one: 













E 




« 




































1 


= 


5 












« 




S 


I 


1 


1 






i 


1 


3 




: 


I 


^ 


i 




1 


1 


a 


c 


1 


3 


.i_ 


^ 


1- 


Melancholia, 


17 


16 






11 


5 


2 


47 


7 


Mania ,- 


11 


20 




■3 


18 


9 


3 


62 


7 


Delusional, 


6 


1 




1 


3 


4 


2 


20 




Dementia, 


:i 


1 








4 


1 


16 


"5 


Hpochal, 


3 


4 






6 


5 


2 


18 


4 


Sexual, 




Z 




"2 








1 




Toxic, 


■5 


3 




1 




J 


1 


47 


15 


Neuropathic, 












1 




Z 


1 


Other Forms. 


"3 


■3 




2 


■3 




i 


17 


6 


Total. 


46 


50 


10 


9 


41 


35 


12 


230 


45 



Total numbers. 870; total heredities, 193; unknown. 230; doubtful, 45; 
parents of known and reported heredities. 22+; parents of doubtful, 5+; 
parents of unknown, 26+. 

From this table it appears that there was an inheritance 
of insanity in some degree in 22+ per cent, of the num- 
ber. 

It also appears that heredity may, and often does, become 
a most important factor in the causation of insanity; but- 
how great its importance may be in this respect does not 
appear from the above statistics, nor indeed from the statis- 
tics of other institutions for the insane. These are neces- 
sarily of a very imperfect character. We are nearly always 
obliged to depend upon persons who attended the patients 
when they were admitted for information in this respect, 
and unless they are intimately acquainted with the family 
history they are unable to give it with accuracy. In many 
cases when attended by relatives, it is not easy to obtain 
the family history in this respect, as it is not unfrequently 
regarded as important to conceal the fact of the existence 
of insanity in the family. Still, imperfect as they are, they 
may serve as a basis for some consideration relating to the 
subject of heredity; for while we understand little relating 



jdbyGoOglC 



Insane Heredity. 3 

to the essential nature of heredity, we do know something 
about its phenomena. 

Heredity may be defined as that peculiar quality or prop- 
erty of organisms which enables them to transmit their es- 
sential characters to their descendants. Its action appears 
to be universal and covers all forms of life, whether vege- 
table, animal, or human. Its roots reach down into the 
very elements of all living structures, and it appears to be 
one of the essentials of life itself. It passes beyond the 
bounds of healthy functions into morbid conditions of both 
mind and body. But the modus operandi of this marvelous 
process — this universal biological law — has always hitherto 
remained, and perhaps still does remain, a sealed book. 
By what process or method this influence may extend over 
several generations, manifesting itself in some particular 
form or disease in one or more persons, and in no others; 
affecting one member of the family and not another of the 
same family; how a peculiar character, such as the color of 
an eye, the hair, the skin; the size and form of the mouth, 
the teeth, the lips; the contour of the chin, the cheek, the 
nose, the hand, the foot; the mental and moral characteris- 
tics, and even peculiar movements of the hands and body, 
may all appear in one or more individuals in a generation 
and in no others, these physiological processes have, I 
say, remained a mystery while observers have been obliged 
to occupy themselves with the study merely of certain phe- 
nomena and characters in organism which we say are due 
to hereditary influences. 

Within comparatively few years, however, the study 
of this subject has received a new impetus. It now relates 
not so much to the character of the results as it does to 
the intricate and delicate arrangements which nature has 
provided for securing these far-reaching results. This part 
of the subject, however, is too complicated and abstruse, 
and the terms used in its description are too technical to he 
introduced in a report of this kind. My present purpose 
has to do with another phase of the subject, viz.; that re- 
lating to mental disorders. 

In a condition of ordinary health the thought process 



jdbyGoogle 



4 H. P. Steams. 

occurs automatically except during the hours of sleep, and 
even then it may eventuate in what we call dreams, the 
character of which the person has a sort of subconscious 
realization. Its activity, however, during dreams is not sub- 
ject to the will of the' individual. During our waking hours 
the impressions received upon the end organs of tlie five 
senses, and from the revival of the stored -up experiences 
of the past, give rise to mental activities which express 
themselves in the form of speech or motion, if they eventu* 
ate in outward manifestations at all. But it is frequently 
the case that these thought activities do not pass from the 
brain and discharge themselves in any form of outward 
manifestation. They can be arrested and examined by the 
personality; be approved or disapproved; be analyzed or 
modified, and formed into new combinations which commend 
themselves more or less fully to the personality and thus 
become opinions and beliefs; or they can be disapproved 
and rejected. 

Such is a brief word in the physiological action qf that 
portion of the brain, the function of which relates to sensa- 
tion, preception, and thought, when it is in a state of nor- 
mal and conscious activity. 

But when by reason of unfavorable influences and 
experiences, such as over -exertion, long-continued anxiety, 
uncertainty, and worry, ill health; or from the effects of 
poisons acting upon its delicate structure, such as foul air, 
alcohol, opium, and the products of disorganized tissues of 
the system which have not been eliminated from it; or again 
from the influence of unfavorable inheritances; these physi- 
ological activities of the brain become deranged and changed 
in character so that the actions and reactions are no longer 
normal, the effects are manifested in states of mind which 
are termed insanity. In other words that condition of mind 
which we term insanity arises from or consists in the mor- 
bid and disordered activities of certain portions of the brain 
and general nervous system. 

Now when the brain has once become deranged in its 
normal action or has passed through the storm of excite- 
ment attending an attack of mania, or the profoundly 



jdbyGoOglC 



In5ane_ Heredity . 5 

depressed condition usual in melancholia and other forms of 
insanity, its cell structures do not readily return to a state 
of healthy function. On the contrary, there is likely to 
remain for a long time a super- sensitive condition of it, and 
more or less of probability that from the experiences of 
uncertainty, trouble, and disappointment, there will again 
occur a disorder of mental function. Habit of action in the 
normal condition becomes a sort of second nature to most 
persons — much more does a habit of action which has been 
established in a disordered state of the brain tend to become 
permanent, or liable to return again if recovered from. 
Now it is this acquired or inherited tendency of the brain 
towards unstable and morbid action that is likely to be 
transmitted to succeeding generations. Indeed, I think it 
may be claimed without fear of dispute that this condition 
of the brain when it has once eventuated in insanity is 
more likely to be transmitted than almost any other morbid 
tendency. 

It should be added in this connection that it is not nec- 
essary that the peculiar condition in the parent should have 
eventuated in actual insanity to insure its doing so in the 
offspring. It is not unfrequently observed that qualities of 
mental action in one parent which have been regarded as 
notiiing more than eccentricities or peculiarities — sometimes 
eventuating in periods of depression and a morbid irritability 
— when crossed with certain characteristics in the other 
parent, the nature of which may not be known — not un- 
frequently develop into one of actual insanity in succeeding 
generations. 

Again, a tendency towards some one diathesis or form of 
disease in one generation may assume in a succeeding gen- 
eration a different form of disease or diattiesis. For 
instance, a consumptive or rheumatic parent may have child- 
ren who are quite free from tendencies towards these par- 
ticular forms of disease and yet inherit a brain of such an 
unstable organization that it has attacks of insanity; or 
vice versa, a parent who has been effected with an attack 
of insanity may have children with a consumptive or scrof- 
ulous tendency. 



jdbyGoOglc 



6 . H. P. Steams. 

On the other hand, if one of the parents has a vigorous 
constitution and a nervous system unusually robust, and is 
endowed with a tendency to longevity, these qualities may 
prove sufficiently potent to overbalance any weakness and 
tendencies toward disease in the other parent and the off- 
spring may be healthy, though in some degree affected by 
the infirmities of the weaker parent. Some persons and fam- 
ilies also seem to be endowed with unusual ability in trans- 
mitting healthy characteristics of race and nationality, and 
this may prove an important factor towards eliminating ten- 
dencies to disease on the other side of the house. In these 
two characters or qualities, which we may assume exist to 
some extent in all healthy persons, there is contained a 
power of incalculable value to the human race — indeed, one 
essential to its continued existence — that is a tendency on 
one side to overcome weakness and disease on the other 
which might otherwise continue to increase, especially 
under the influence of unfavorable environments. 

From these considerations the danger from consanguin- 
eous marriages becomes apparent. Statistics relating to this 
subject, however, appear at first view to point in opposite 
directions. For example, the ancient Egyptians, the Per- 
sians, and Syrians and many other'nations were accustomed 
to contract consanguineous marriages in all degrees of rela- 
tionship. The Seleucidae and Lagidae followed this prac- 
tice during long periods, and both these races were remark- 
able for their vigorous and healthy physical constitutions and 
great power of endurance. 

On the other hand, the tables of statistics compiled by 
Dr. Bemis and others present abundant evidence going to 
demonstrate that among some families living in more recent 
times intermarriages result very disastrously. The children 
are not unfrequently deaf-mutes or idiots, scrofulous, phthis- 
ical, insane, or deficient, both in body and mind to some 
extent. 

Again, experiments with interbreeding cattle, possessing 
certain strains of blood, seem to prove that this may be 
continued for several generations without apparent unfavor- 
able results, and possibly with good results in some direc- 



jdbyGoOglC 



Insane Heredity. 7 

tions. I formerly had a flock of India pigeons which inter- 
bred apparently without deterioration for many years. They 
remained healthy, strong, and very prohfic. The same is 
true in reference to some families of rodents. 

On the other hand, there is much evidence that this can- 
not be practised with other classes of animals without 
unfavorable results. This is markedly the case with swine, 
dogs, hens, etc. It is necessary to often introduce new 
strains of blood to prevent rapid deterioration. 

The question now arises as to how we can reconcile 
these two classes of results which seem to be so opposite 
in their character. It appears to be evident that the mere 
fact of consanguinity is not of itself sufficient to explain 
the degenerative characters which are found to exist in some 
cases where it has been a factor. We have found its 
presence in numerous instances among different families of 
man and various classes of animals without apparent unfav> 
orable results. Therefore, when they do appear we must 
look for the cause in some other direction. We have de- 
fined heredity as that peculiar property of organisms which 
enables them to transmit their essential characters to their 
descendants. This peculiar function must therefore cover 
the transmission of bad as well as good characteristics, 
unhealthy as well as healthy conditions of the system ;and if 
there existed no tendencies towards disease, and no imper- 
fections, mental or physical, none could be transmitted. In 
other words, if both parents were in a state of perfect 
health, no deleterious results would follow in-and-in breed- 
ing, and it could be practiced indefinitely without harm to 
offspring. But in the present state of our civilization it is 
safe to conclude that there are no persons in absolute per- 
fect health, either of body or mind, and the same is true, 
though in a less degree, among other orders of animals. 
Different orders of animals, however, differ in this respect 
as much as different families of man. As a rule, cattle, 
rodents, and many classes of birds are healthy, while 
swine, hens, dogs, and sheep are subject to frequent at- 
tacks of disease; and it seems to be true that very largely 
as different orders of all animals, man included, are brought 



jdbyGoOglC 



8 H. P. Steams. 

out from a state of nature and subjected to the conditions 
pertaining to a state of what we call civilization, do they 
become effected with disordered conditions. We have not 
yet learned how to avoid these unfavorabie results to either 
men or animals, and it appears that as the artificial re- 
straints and exactions of life become increased and intensi- 
fied, especially in the great cities, the various forms of dis- 
ordered function and disease multiply. 

In this way we see how much more danger there is that 
a morbid heredity will increase. Like tends to beget like, 
and if two persons with a tendency towards the same con- 
stitutional diathesis or disease marry, the tendency towards 
this disease becomes double in the offspring. In case only 
one parent has a morbid tendency, the influence of the 
other, if healthy and strong, may be sufficient to overcome 
and eliminate it in the offspring. 

Now persons and animals of the same family necessarily 
inherit the same tendencies toward health and disease to a 
greater or less extent, according to the degree of consan- 
guinity. Persons with no blood relationship are much less 
likely to have like tendencies. Indeed, they are likely to 
have characters which would have a counteracting influence 
upon such unfavorable tendencies in others. 

We readily, therefore, perceive the danger of unfavorable 
results from marriages among blood relations, not because 
of tile mere fact of relationship, but because of the proba- 
bility of increasing characters and tendencies towards any 
special forms of disease which may exist in both parties. 

Tlie question arises whether a person who has passed 
through an attack of insanity should contract marriage. It 
would not be easy to formulate a rule which would cover 
all cases and never be set aside; but in view of the fact 
that when one has once been insane he will ever after- 
wards be in great danger of another attack, it is of the 
greatest importance that all parties concerned should have 
a full understanding in relation to this feature of the case. 
The practice, more generally pursued, of keeping the fact 
that a person has had such an experience concealed, especi- 
ally when the party is a female, cannot be too strongly 



jdbyGoOglC 



Insane Heredity. 9 

censured. If after a full explanation, and the other party 
has consulted friends and obtained professional information 
as to the future prospects, he or she chooses to go forward 
and consummate marriage, it is in some respects a matter 
of their own concern. It would be so entirely in many 
cases if no children were to be born' of such marriages, 
who would always live under the shadow of an impending 
danger from the beginning. The right of persons to inflict 
the state with children having such an inheritance, is very 
doubtful. If, however, the female is past the period of 
child-bearing, the objections to marriage, so far as they 
relate to children, would be nil. But when there is reason 
to anticipate a family, persons contracting marriage assume 
a responsibility which few physicians should be willing to 
advise. In case the insanity has been the development of 
an inheritance and has existed in either immediate or 
remote direct ancestors, the risk becomes greater. If on the 
other hand, the attack can be attributed to some accidental 
experience or physical disorder, and the other party has a 
vigorous constitution and good inheritance, the danger be- 
comes much less. In such cases there exists a reasonable 
probability that the stronger and more stable qualities of 
nerve tissue will triumph over and eliminate the weaker 
ones. It is true that there always exists a tendency in 
weak and partially diseased organisms, under favorable con- 
ditions, to return to a state of health, and if not, to die. 



jdbyGoOglc 



ANALGESIA OF THE ULNAR NERVE IN 
THE INSANE.* 



By DR. ARRIGO GIANNONE. 

FROM the time when Biernackt first called attention to 
the fact that in tabes there was very frequently anal- 
gesia of the ulnar nerve where it lies in the humero- cubital 
canal, a fact which, according to his researches in twenty 
individuals affected with tabes dorsalis, was verified in 
seventy per cent, of the cases, there have been many 
other observations made, the greater part of which tend to 
the conclusion that in some forms of mental disease this 
symptom may be of diagnostic importance. Cramer, on 
studying fifty-one paralytics, found that thirty-nine of them, 
that is about seventy-six per cent., presented an absolute 
analgesia of both sides, and seven had it on one side only, 
so that in all there were forty-six cases or about ninety 
per cent. In non- paralytics on the other hand there was 
marked reaction to pain in seventy- nine of the cases, so 
that from the very different behavior of the two classes 
investigated, he deduced th^ fact that this analgesia might 
serve as a point in differential diagnosis. 

Otto Snell '•" followed Biernacki and Cramer and 
studied over one hundred insane, of whom twenty-five 
were paralytics and the other seventy-five had been selected 
from epileptics and other forms of chronic disease "in which 
we would naturally expect to find the greatest alterations 
in sensibility," He gives for the paralytics these results: 



[10] 

D,j.,.db,GoogIc 



Analgesia of the Ulnar Nerve. 1 1 

Ulnar symptom normal in four per cent, of cases, weak in 
forty per cent., lacking in fifty-six per cent. In non- 
paralytics it was normal in thirty-three per cent,, weak in 
fifty-two per cent, and absent in fifteen per cent. 

Besides this Snell gives in a table the results obtained 
by him in the various diseases examined: 

Nomiiil. Wtak. Abstnl. 

Epileptics 22 S or 23% 11 or 50% 6 or 27% 

Idiots 5 1 " 20" 4 ■' 80" 

Primary Dementia 7 2 " 29" 2 " 29" 3 " 42" 

Secondary Dementia 7 6 " 86" 1 " 14" 

Senile E>«nentla 2 2 " 100" 

PaMiwiacs 21 6 " 29" 13 " 62" 2 " 9" 

Stuporous 6 2 " 33" 4 " 67" 

From these results we may conclude with Cramer that, 
compared with other forms of mental alienation, ulnar 
analgesia is most frequent in progressive paralysis. 

Orschansky *** has published a series of researches 
carried out by him in Mendel's polyclinic, on sane individ- 
uals, on twenty cases of tabes, and on many individuals 
with other diseases. He arrives at the following conclusions: 
"Atiatgesia of the ulnar nerve is not at all characteristic of 
tabes, as in many diseases which are not nervous in origin 
the pain reaction is altogether absent, while, on the con> 
trary, in a certain number of cases of tabes it is neither 
lessened nor absent." 

Boedeker and Falkenberg, "' from results arrived at 
by them very different from those reached by Cramer and 
Snell, conclude that the ulnar reaction is not typical 
of progressive paralysis nor can it be adopted as a means 
of differential diagnosis. In fact they obtained this anal- 
gesla, in the investigation of one hundred paralytic men 
and twenty-five women, in respectively fifty-eight per cent, 
and fifty-six per cent, of the cases while in two hundred 
psychopathic men and one hundred women there were 
respectively thirty-nine per cent, and thirty-three per cent, 

Hillenberg '*' attaches great importance to this symp- 
tom as a criterion of differential diagnosis, and obtained 
from sixty paralytics the following results: Forty-three 
had complete unilateral analgesia, seven had diminished 



jdbyGoOglC 



12 Dr. Arrigo Giannone. 

doiorific reaction and five had unilateral analgesia with 
diminished reaction on the other side, in all fifty-five or 91.6 
per cent. On the other hand in the psy.:hopathtc patients 
83.4 per cent, of the cases presented a normal ulnar 
' reaction. In epileptics on whom he made separate researches 
he found the analgesia in 76.9 per cent, of the cases in 
men and 70,07 per cent, in women or an average of 75.4 
per cent, of all cases. 

The researches of GSbel '" give the following results: 
In fifty-four cases, forty-seven presented total analgesia or 
87.3 per cent., two had analgesia on one side, i. e., 3.5 per 
cent, and five reacted normally or 9.2 per cent. ; in women 
also affected with paralytic dementia, 81.9 per cent, gave 
the pain reaction, in 13.6 per cent, there was total anal- 
gesia and in 4.5 per cent, unilateral analgesia, a result 
altogether opposed to those previously obtained. 

Obregia '^' observes that analgesia is very frequent in 
progressive paralysis (88 per cent.). 

Hess "' brings statistics to prove that "analgesia of 
the ulnar nerve is one essential peculiarity of paralysis 
particularly of men"; in thirty cases, he found total analgesia 
in twenty-two, unilateral in one; in all, twenty-three had 
analgesia of the nerve; of the remaining seven, five felt 
pain and two had doubtful sensation, hence we have these 
proportions, 76.6 per cent, with analgesia and 16.6 per 
cent, without. 

In women the following results were obtained in twelve 
paralytics: disappearance on both sides in five cases, on one 
side only in one (50 per cent.), normal in four and weak in 
two (50 per cent.). 

Taking together these two sets of statistics we find 
that analgesia was present in 69 per cent, of the cases. 

Hey has compiled a summary of all the cases hitherto 
studied and taken the average, and finds that in four 
hundred and seventeen cases of tabes and paralysis, 66,9 
per cent, had analgesia; in three hundred and fifty-four 
paralytics it was present in 70 per cent. 

According to sex, the ulnar symptom was absent in 
73.7 per cent, of two hundred and thirty-two men, and in 



jdbyGoOglC 



Analgesia of the Ulnar Nerve. 13 

45.7 per cent, of seventy-one women. 

Amongst those who were neither paralytics nor epilep- 
tics he found that the ulnar reaction was absent in 16 per 
cent., uncertain in 82 percent, and normal in 82 percent. 
In women these percentages were respectively 9 per cent., 
2 per cent, and 89 per cent. 

From such facts the author concludes that the symptorh 
to which Biernacki has called our attention has a certain 
value; but it would possess a great diagnostic importance 
if we knew to what to attribute the analgesia of non-para- 
lytics. 

In male epileptics Hess found this analgesia in 8.69 per 
cent, of the cases, while in women he could not find it at 
all. He discovered besides that the pain reaction was 
absent for six to twelve hours after a convulsive attack; 
after this time the reaction appeared again and only in 
the case of one woman did the analgesia remain for about 
thirty-six hours, the normal reaction returning after forty- 
eight hours. Hess attaches great importance to this in the 
diagnosis of the epileptic psychosis. 

Finally, there appeared but a short time ago an article 
by Sambo, *•'*' who, while investigating analgesia of the 
peroneal nerve in cases of tabes, found that analgesia of 
the ulnar was present in eleven out of fifteen cases, with- 
out there being any relation between the disappearance of 
this reaction and the disturbances of sensibilrty. 

As will be seen the results obtained do not agree very 
well. Some authors maintain that the disappearance of 
the ulnar reaction is a point of great diagnostic value, while 
others deny it any such importance and, like Boedeker, 
Falkenberg and Orchansky, affirm that ulnar analgesia isnot 
characteristic of either tabes or paralytic dementia. And 
we find the average in progressive paralysis oscillating 
between a maximum of 91.6 per cent. (Hillenberg) to one 
of 56 per <ent. {Snelt- Boedeker) in regard to analgesia; 
while in other mental diseases we find the average for 
non- analgesics to vary between 82 per cent. (Hess) and 
S3 per cent. (Snell). It must be noted, however, that in 
his 91.6 per cent. Hillenberg includes, besides the bilateral 



jdbyGoOglC 



14 Dr. Arrigo Giantione. 

cases, those in which the symptom was presented only on 
one side and those in which the pain reaction was some- 
what diminished, which the other authors have not done. 
They have made an average of itself for this last class or 
else have included them in the normal (Ht-ss). If we take 
this fact into consideration and subtract from Hillenberg's 
figures those cases having a weak reaction, we obtain for 
this author a percentage of 80 having true analgesia. 

My researches on this subject have been chiefly made 
among the insane, not neglecting, however, any cases of 
tabes which have occurred this year in the Sante Spirito 
Hospital, and those met with in the neuro-pathological 
clinic. 

The insane cases which I have studied number two 
hundred and fifty-seven, thus divided; paralytic dementia 
forty- seven, of whom thirty- nine were men and eight 
women; the others were afl^icted with various mental dis- 
orders but were mainly epileptics, idiots, alcoholics, para- 
noics and cases of dementia; of these one hundred and 
seventy-three were men and thirty-seven women. 

The method used in the researches did not differ at all 
from that indicated by Biernacki in his article; the patient 
was made to flex the fore-arm on the arm, and there the 
nerve-trunk was pressed on with moderate force by the 
second finger while the thumb rested on the front of the 
epicondyle of the humerus. In normal individuals the fol- 
lowing symptoms are called forth by this pressure: 

1st. A contraction of the muscles innervated by the 
ulnar. 

2d. A pain more or less acute, but very characteristic, 
and one which can with dif!iculty be borne without some 
reaction on the part of the patient. 

3d. A manifestation of this pain consisting in a change 
of countenance, flexion of the arm, or exclamation of pain. 

Now, of these signs, in my researches, only one has 
been constant and unmistakable, and that is the contrac- 
tion of all the muscles supplied by the ulnar nerve, a con- 
traction which cannot escape the finger of the hand which 
holds flexed the fore-arm of the patient. 



jdbyGoOglc 



/4nalgesia of the Ulnar Nerve. 15 

On the other hand the external manifestations, such 
as changes in the face and exclamations are entirely want- 
ing in certain mental states in which the patient succeeds 
in mastering every sensation reaching him from the outside 
world, and it has often been my tot to see, especially in 
paranoics and some idiots, the face remain tranquil and 
impassive, revealing no trace whatever of suffering while 
the arm was strongly Hexed, and the shoulder quickly 
drawn upward and backward. And so much the more must 
we take into consideration this manifestation, in as much as 
the face changes may be so slight and fleeting as to be almost 
gone unless the countenance is most attentively watched, 
especially when the physician has not yet had much prac- 
tice in such studies. 

Another fact to which Boedeker and Falkenberg called 
attention in their article is the following: often examining 
patients with intervening spaces of time the ulnar symptom 
was found to vary. It has also happened to me in more 
than one case that a person in whom we had perhaps 
found analgesia at the first examination, on being exam- 
ined again after some length of time presented the 
characteristic reaction. The above named authors in order 
to explain this, have considered it to be due to the strength 
exerted by the observer, which may vary quantitatively 
from day to day. But I would add these hypotheses : 

1st. Want of practice in research, by means of which, 
at first, a weak reaction may excape the observer. 

2d. The nature of the anatomical lesions of the ulnar 
nerve, on which I shall dwell briefly before closing. 

3d. The condition of the patient, especially that of his 
nervous system at the time of examination. 

Having premised these considerations I shall now give 
the results of my observations on forty-seven cases of 
paralytic dementia. In thirty- nine men we found: 

h sides 

< side only 
Weak pain reaction 

Normal " " 



jdbyGoOglC 



16 Dr. Arrigo Giannone. 

The percentage would stand thus: 

1 absent in 59 % ol the cases, 
weak in 25.6 
normal in 15.4 " 

In the eight women examined it was 
Absent In 2 or 2S per cent. 
Weak in 2 or 23 
Normal in 4 or 50 " 

Summing up these, the ulnar sign in forty-seven cases 
of paralytic dementia gave the following results: 

Absent on both sides In 23),- c , . , . 

■■ ■• one ■' only z)^ "' «-2 P" ««■ 
Weak in 12 25.6 ■' 

Normal In 10 21.2 

If we compare the statistics here given for the two 
sexes we must notice the fact already remarked by G6bel, 
viz.: a quite opposite condition of things in the women 
affected with progressive paralysis to that found in the 

Having drawn attention to this fact, we shall presently 
see what relation exists between it and the other principal 
symptoms of paralytic dementia and also between it and 
the period at which tlie disease originates. 

In regard to this last point, analgesia is found in cases 
(if two, three or six months duration just as Biernacki's 
sign may be found normal or absent in forms of the same 
duration. Does this indicate tliat the disease in the first 
instance will run an acute course, while in the second it will 
assume tlie more chronic character so often found in this 
disease? We are certainly not justified from the records of 
one case, in risking a decisive opinion, but one may ven- 
ture on a hypothesis at least. A patient was examined by 
me towards the end of November last, who presented this 
cubital analgesia; now in this man the course of the dis- 
ease had been very rapid, and though of little more than 
a year's duration it was already very far advanced. 

As far as the general course of the disease is concerned, 
then, nothing can be deduced from the more or less early 
presence of the analgesia. 



jdbyGoOglC 



/Analgesia of the Ulnar Nerve. 17 

In all the patients there was disturbance of the motility 
of the pupil, and in' twenty-three there was rigidity, but 
these did not bear any constant relation to the analgesia 
since in many cases with rigidity of the pupil the reaction 
to pain was normal. In ten the iris reflex was slow, in 
three normal and in one case this could not be studied as 
the patient was affected with amaurosis. The knee-reflexes 
were exaggerated in twenty-two, normal in four, weak in 
two, absent in eight and variable in one. With regard to 
dysarthria, these were absent in eleven, slight in two, and 
present in twenty-four. 

The existence of syphilis, contracted for the most part 
in early youth, was ascertained in fourteen cases; in seven 
cases it had almost certainly existed and in the others 
nothing definite could be discovered from the examination. 
Abuse of alcohol could be proven in eighteen of the cases; 
for the rest we may repeat what has been said with regard 
to syphilis. If we isolate these facts and place them 
in relation to the disappearance of the ulnar sign we see 
that there exists no true correspondence between them and 
the analgesia; we can, however, accept Snell's dictum that 
together they form a very complete unity of symptoms. 
The' Argyll-Kobertson symptom, the exaggeration of the 
knee reflex, the dysarthria, and the absence of the ulnar 
sign are, if not all found in the same patient, at least 
encountered in an almost equal number of cases, so that 
the percentage of each would be found to be about the same. 
We therefore believe that the ulnar sign may be given this 
value, viz.: that, analgesia of ihe ulnar nerve to pressure in 
the groove behind the elbow, may if not exclusively, yet when 
joined with other signs, have a certain diagnostic significance. 

The other insane studied numbered, as has been 
already mentioned, two hundred and ten, of whom one 
hundred and seventy-three were men and thirty-seven were 

Among these the ulnar symptom was 
Absent in 53 or about 25 per cent. 



jdbyGoOglC 



18 Dr. Arrigo Oiannom. 

If we take the sex into consideration as was done in 
the cases of paralytic dementia we find it in 173 men to be 
Absent in 44 or 25.4 p«r cent. 
Weak in 43 or 24.9 " 
Normal in 86 or 49.7 " 



In thirty-seven women it 


was 


Absent in 9 or 


24.3 per < 


Weak In 7 or 


18.9 ■■ 


Normal in 21 or 


56.8 '■ 



As we can see there exists no difference between the 
men and women, the percentage of individuals with anal- 
gesia being almost equal (2S.4 per cent, and 24.3 per cent.) 
There is a slight difference between those showing weak 
action (24.9 percent, and 18.9 per cent.) a difference which 
may be overlooked and may be attributed to the different 
activities of the nervous system in men and women. 

If now we make, as did Snell, a division of these 
patients according to the disease by which they are affected 
we have: 





Total No. 


Absent. 


Weak. 


Normal, 












Number 






P.. ten 


Epilepsy 




51 


11 


21.6 


14 


27.4 


26 


57.0 


Alcohol ism 




32 


10 


31.2 


7 


21.9 


15 


46.9 


Paranoia 




37 


10 


27.1 


10 


27.1 


17 


45.8 


IJIocy 




57 


12 


23.5 


12 


23.5 


27 


53.0 


Senile Dementia 


2 










2 


100.0 


Consecutive 




20 


5 


25.0 


15 


25.0 


10 


50.0 


Varines 




17 


5 


29.4 


2 


11.8 


10 


58.8 



Now comparing these figures with, those obtained for 
the paralytics, we find a very much greater frequency of 
cubital analgesia in general progressive paralysis than in 
all other forms of mental disease, whether these latter be 
compared separately or collectively. However, the differ- 
ences between these figures and those obtained for paraly- 
tic dementia are nut such as to authori2e us to place the 
disappearance of the ulnar symptom among the differential 
Jiagnostic characteristics between this and other psycho- 
pathies. 

Here are the results obtained from fifteen cases of tabes 
which 1 examined: 



jdbyGoOglc 



Analgesia of the Ulnar "Nerve. 19 

{Absent 60.0 per cent. (9 cases) 
Weak 13.3 " (3 " ) 

Normal 26.7 " (4 '■ ) 

With regard then to this disease we can say: 

1st. That analgesia of the ulnar nerve has no relation 
to the other symptoms. 

2d. That, considered by itself, it has a very limited 
importance, being met with much less frequency than the 
Argyll- Robertson and Westphal symptoms. 

3d. That it is not pathognomonic of tabes dorsalis, 
being present in other nervous diseases. 

From these data we may draw the following conclusions: 

1st. The disappearance of the ulnar symptom cannot 
be excluded as a point in the differential diagnosis between 
paralytic dementia and other psychopathies. 

2d. The analgesia considered as a symptom per se, 
cannot have, either in tabes or progressive paralysis, any 
importance as a pathognomonic sign, though it may be of 
some value when conjoined with other more important 
symptoms of the disease. 

3d. Having recognized that the frequency with which 
this symptom is found is almost the same in tabes and in 
progressive paralysis, we have another argument in favor 
of the similar nature of these diseases. 

There remains yet several points to elucidate, which it 
was impossible for me to accomplish owing to lack of 
material. Why should there be a difference in the com- 
portment of the analgesia in progressive paralysis, between 
men and women? To what is due the relatively greater 
frequency of the analgesia in alcoholic compared with other 
psycopathic maladies? What is the cause of the variations 
in intensity spoI<en of above.' These two last facts would 
seem to point to a lesion of peripheral origin, a neuritis, 
probably similar to that discribed by Moxter (") in the 
ulnar nerve of a tabetic individual. In this case the neu- 
ritis was really of syphilitic origin for he also mentions that 
in the vessels of the nerve there was present an obliterating 
endarteritis. Unfortunately this objective examination took 
place several months before the publication of Biernacki's 



jdbyGoOglC 



20 Dt. Arrigo Giannone. 

paper and therefore it was not noted whether or not the 
patient had ulnar analgesia. 

Also there have been noted In acro-paraesthesia "^' and 
in neuritis induced by leprosy, '^-" analgesia of various 
nerve trunks and among them of the ulnar; then, too, in 
alcoholic polyneuritis, both in the form of pseudo-tabes and 
paralytiform alcoholism, there may be found analgesia of 
the ulnar and other nerve trunks. 

But the disease of this nerve is not always of peripheral 
origin. Gowers, "■" apropos of the diseases of the ulnar 
nerve says that it may be attacked in all. affections of the 
spinal cord and that it is the first to become involved in 
degenerations ascending from the dorsal to the cervical 
origin. In the following four cases the connection between 
the spinal lesion and the ulnar analgesia was easily traced 
as both were unilateral. In two cases of hemi-section of 
the spinal cord for injury there ensued, the characteristic 
Brown-Sequard syndromata. These cases have already 
been described by Dr. Vespa."" In another case of a 
syphilitic meningo-myelites corresponding to the 6th and 7th 
dorsal vertebrae the above mentioned symptoms were also 
present. In the fourth case the patient was an alcoholic 
with right hemiplegia. In the first and second of these 
cases there was ulnar analgesia on the hemiplegic side, in 
the third and fourth the reaction was somewhat weak and 
on the other side it was normal. 

With these facts it is difficult to pronounce on the 
anatomical nature of the analgesia. 

I must here tender my thanks to Professor Mingazzini 
for assistance he has so freely given me during my 
researches. 



jdbyGoOglc 



Analgesia of the Ulnar Nerve. 

Epilepsle. Nnrol. CinlrU, 1895. 

7. Cobcl. WclWre UnWrsuchuneen uber dii UlnirlHymploir b«l GdsKskr 
NnnI, Ctotril. 1895. 

8. ObrcEla. rcsaml In Giictu dcEll Osptdill t delta clinkhe, 1896 No. 19 p. 199. 

9. Heu. Uiber dai UlnulsiymplDn (Blemackl) tol GclslHknnlwn, .ff/((i 
Ziiluhr.fur Pifck: p. 67. vol, vll, 

10. A. Simbo. Anile«sle d« Ulni>ii»Un>in« (BItmickO u«<t dts Pcronaeu 



JigilizedbyGoOglc 



Report of a Case of Brain Syphilis Heroic- 
ally Treated with Mercury, Fol- 
lowed by a Mercurial Neuri- 
tis and Recovery. 



By WILLIAM C. KRAUSS, M. D. 

Professor or Ncivous Diseases. Medical t>e[iarlinen1 ol NliEira 
UnlvMslly, Buffalo. N. Y. 

THE following case of specific Meningo-encephalitis is 
interesting from the fact that it shows how far such 
cases are amenable to treatment, and also the amount of 
treatment such cases require in order to attain results. 
These cases of brain syphilis are the only ones where com- 
plete recovery may be expected, if the anti-syphilitics are 
carried, if necessary, to the point of intoxication. Cases of 
arteritis or endarteritis with consequent embolus or thombus 
formation, or disruption' of the vessels with destruction or 
compression of the brain tissues are least liable to satisfac- 
tory treatment. While gummatous tumors if small and 
located in the meninges offer better advantages, larger 
syphilomata extending into the cortex, or affecting the base 
of the brain, cause destruction of neighboring brain tissue 
and are to be reckoned in the same class, as regards results," 
with the sequellae of endarteritis. In other words, complete 
or even partial recovery is extremely doubtful in ■ all cases 
where the brain substance has been impinged upon and the 
prognosis must be rendered with great caution. On the 
other hand, cases of meningitis or meningo-encephalitis 
offer much better results and a hopeful prognosis dependent 
of course upon the thoroughness and audacity of the treat- 
ment. 

[22] 



jdbyGoOglc 



Report of a Case of Brain SyphiHs. 23 

/Inna C, age twenty-five years, height five feet four 
inches, weight 120 pounds; complexion dark, "constitution 
rather frail. Father and mother are living and healthy', 
grand-parents lived to old age. There is no family history of 
syphilis, tuberculosis or cancer obtainable. She never had 
any diseases of infancy and was always in the best of 
health. In 1891 she committed an indiscretion, ran away 
from home and lived for four years in a sporting house. 
Here she acquired syphilis and was treated for primary and 
secondary symptoms. In September 1895, she first began 
to have pains in the head, sharp, shooting and continuous, 
beginning at the vertex and radiating downwards in all 
directions. The head was tender and sensitive and felt as 
if "something was growing inside of it." She complained 
much of nausea and vomited occasionally. Bowels were 
loose, and sleep was much disturbed. 

Her physician presaibed mecurial preparations and potas- 
sium iodide. The headaches not diminishing, I was called 
in consultation Nov. 10, 1895, and found a thin, pale 
emaciated young woman, whose body and extremities 
were covered with the characteristic roseola of syphilis, suf- 
fering with excruciating pains "all over the head." The 
head was very sensitive on pressure and was very tender 
and sore over the nucha. Temperature was normal, pulse 
was 80. I advised mercurial inunctions and protiodideof mer- 
cury pills, half grain three times daily. After the fourth in- 
unction salivation appeared and immediately the head pains 
began to diminish, so that in three days the head was entirely 
free from pain and she was able to be about attending to her 
duties. The inunctions were discontinued but the protiodide 
pills were taken regularly. 

She was practically in good health for six weeks, when as 
the rash began to disappear the headaches reappeared with 
greater intensity than ever before. They were accom- 
panied by dizziness, tendency to fall to the right, nausea, 
vomiting and photophobia. She could not see to read or 
write and complained of pain in the eyeballs. 

On January 3rd, 1896, 1 was again called to see her and 
found her more emaciated and debilitated than at my first 



pigiLizedbyGoOglc 



24 U^iltiam C. Krauss. 

visit. She complained of the head pains, nausea and vom- 
iting, unable to keep even water on her stomacli, while 
visioo was markedly diminished and the room was heavily 
curtained on account of the photophobia. The acme of pain 
she referred to the left side of the head over the frontal 
and parietal regions, with sensitiveness to percussion over 
this area. She has of late, been misapplying words, call- 
ing for a spoon when she wanted a tooth brush, cigarette 
for a glass of water, would call the nurse by the wrong 
name and at times not be able to make herself understood 
at all. 

The lower part of the face is slightly paretic. The 
eyes: — ocular muscles are not affected as the orbits are 
freely movable in ail directions. The pupils are widely 
dilated with some difference between the two sides. The 
fundus shows an acute papillitis (choked disc) on both sides. 
Audition, olfaction, gustation and sensibility of the face 
unimpaired. Tongue protrudes slightly deviated to the 
right. 

Extremities. — There exists a paresis of the whole right 
side of the body, face, tongue, arm and leg. Dynamom- 
eter test of the hands results as follows: 

Right. Left. 

March 2. 24 29 

" 6, 272 32 

" 8, 30 34 

" 15. 26 30 

'• 31, 31 35 

April 10, 32 42 

There is no disturbance of the general sensibility. Ten- 
don reflexes are present, not exaggerated and without any 
preceptible difference between the two sides. 

On March 3rd while on a couch she complained of the 
right hand getting numb and found she hud no power over 
it, hand was cold and finger nails were blue. On attempt- 
ing to eat some bread and milk shortly afterward, found 
she could not swallow, would choke her and strangled; on 
attempting to place her in bed, the right leg was also pare- 
tic and for s<ime minutes she lost all power of speech, but 
was conscious and heard what nurse was telling her. The 



jdbyGoOglC 



Report of a Case of Brain Syphilis. 25 

whole attack lasted no longer than five minutes; says the 
hand and leg felt forcibly drawn downwards. 

March 4. She had a similar attack of paresis, affecting 
the right arm and leg, lasting only "a minute," During 
the day and night the right arm and leg would contract 
forcibly, the arm flexed at elbow and wrist joints and 
adducted at shoulder. The knee joint would be fiexed and 
leg flexed on thigh. Her husband states that these spells 
occurred very often during the night and on two occasions 
awakened her. 

March 8, She is thoroughly salivated so that she can 
hardly speak. Saliva flows from her mouth. She is fed by 
enemata and has been for four weeks. 

March 25. The pains are very much better, there is no 
longer any nausea, appetite is good, bowels are regular. Ex- 
amination of the fundus shows the papillitis receding. The 
salivation still continues. 

March 31. The headaches are growing less in severity 
and are confined to the right side of the head. Vision is 
improving and the photophobia has disappeared. Has not 
vomited since March 21st. Appetite is good and bowels are 
regular. 

She has been receiving one-half grain of morphia and one- 
sixth grain bichlorideof mercury hypodermatically since Febru- 
ary 1st, along with tonics, enemata and a mouth wash. She 
continued to improve daily, and on April 30 I ceased to see 
her daily having asked her to come to my office once 
weekly for three months. The protiodides were continued 
during this time, but not with much regularity. She has 
been in the best of health these three months, rode a bicy- 
cle and thoroughly enjoyed herself. On September 1, 1896, 
not having seen her for three weeks, was called to see her 
and found the old trouble lighted up again. Headaches, 
nausea, vomiting, mental dullness, prostration and papillitis 
were as before present. I determined to salivate her as 
speedily as possible and injected fifteen minims of a solution of 
bichloride of mercury, one third grain to ten minims night 
and morning, along with inunctions of the yellow oxide of 
mercury ointmenj to the elbow and knee joints. 



jdbyGoOgle 



26 IVilliam C. Krauss. 

On September 10th salivation appeared and improvement 
bigan, which continued until she regained fairly good 
health. 

As soon as the cerebral symptoms disappeared and her 
usual good health was expected to return, she began to 
complain of weakness of the hands and arms, tiredness in 
walking and of pains in the elbow and knee joints. These 
persisted in spite of all manner of treatment. bxamining 
the joints there was found no tenderness in the joints 
themselves, no pain on rubbing the joint surfaces together, 
no swelhng, redness or increased temperature. Assuming 
therefore that the pain was not articular or rheumatic it 
occurred to me that a neuritic process might be present, 
due to the mercury, inasmuch as the joints implicated were 
the ones which received the inunctions. This proved to be 
the case inasmuch as there existed great tenderness over 
the nerve joints in the upper and lower extremities, marked 
weakness of the hands, and a slight degree of leg drop. 
She complained of giving way of the hands, would let 
dishes fall to the floor, had difficulty in buttoning her 
clothes and would stumble and trip while walking. The 
tendon reflexes were markedly diminished; the patellar 
reflexes hardly responding to the stimulas. 

Sensation was little if any affected; trophic disturbances 
were also wanting. 

Electrical examinations of the arm muscles showed quan- 
titative changes only, the peroneal muscles acting in a sim- 
ilar manner. 

Analysis of the case shows it to be a specific meningo- 
encephalitis affecting the frontal and parietal lobes of 
the left hemisphere followed by a toxic neuritis. That it 
was not a gummatous tumor may be explained by the targe 
extent of territory covered, reaching from the longitudi- 
nal fissure to the inferior frontal convolution and perhaps 
extending to the base of the brain, partly. 

The paresis of the right leg, arm and face with aphasia 
and paraphasia, the history of several attacks of Jacksonlan 
epilepsy limited to the right side, the absence of distur- 
bances of the crania! nerves alt point to the left cortical 



jdbyGoOglC 



Report of a Case of Brain Syphilis. 27 

region as the seat of disease. That the pathological 
process had not interfered permanently with the functions 
of the cortex, is proven by the absence of all symptoms 
denoting brain destruction and the return of those which 
were but temporarily affected. As such, may be mentioned 
the aphasia, the hemi-paresis and the optic neuritis. These 
symptoms, as present, plainly showed some lesion to the 
brain cortex, affecting the superficial layers only, either 
through' pressure or as is most probable by a superficial 
inflammatory process of a specific nature. 

The amount of mercury administered is almost incredible. 
Hypodermatic injections into the buttocks of about one and 
one third grains of the bichloride daily would be a toxic 
quantity even to the majority of syphilitics, but this amount 
injected daily for ten days shows to what extent mercury 
is tolerated by some of these cases. Along with these 
injections during the first attack the hair was shaven 
closely over the left parietal region and inunctions of the 
yellow oxide ointment were made daily. During the second 
attack these inunctions were made to the elbow and knee 
joints, inner surfaces, and here the toxic neuritis started. 

Regarding the case as a desperate one on September 1st, 
18%, it was either heroic action or loss of the patient and 
informing the husband of the results of mercurialization, 
started with the injections as before mentioned. The 
iodides were not tolerated even in very small doses, and 
their cessation was quickly determined upon. 

The ptyalism was not as severe and protracted during 
the second attack as the first and quickly subsided on 
withdrawal of the mercury and a mouth wash consisting 
mainly of tincture of myrrh. 

Just how long the patient will remain free from another 
attack is difficult to say, inasmuch as all mercurial treat- 
ment must for the time being remain suspended, but should 
the head symptoms again light up I would not hesitate to 
follow out the same vigorous treatment. 



jdbyGoOglc 



INTERACTION OF SOMATIC AND 
PSYCHIC DISORDER.* 



By JAS. G. KIERNAN, M. D., Chicago. 

Foreien Associate Member French MeJko-Psycholoeicil Associnilon: Fellow ol Ttie 

Chicago Acniemv o( Medicine: Professor of Forensic 

Pjychl.lry. Kenl Collee* of La*. 

'TpHAT psychic and ordinary somatic disorder interact lias 
' long been an established fact. Popular belief in the 
resumption of the faculties just before death demonstrates how 
wide spread recognition of such a relation is. This popular 
belief, though well founded, is like all popular medical beliefs, 
exaggerated. Kheumatism, for example, exerts a temporarily 
favorable influence on insanity. Cases of secondary con- 
fusional insanity attacked by rheumatism, often become 
perfectly rational during rheumatic hyperpyrexia, resuming 
the old condition on recovery. 

Hebephreniac dements are attacked with acute articular 
rheumatism with much swelling of the joints. When the oedema 
of the joints suddenly disappearsand high fever succeeds, they 
are often very quiet and subdued, talk rationally and are 
careful about dress and person. This improvement is but tem- 
porary in character, the patient becoming demented on recov- 
ery. A case of melancholia attonita, was attacked by acute 
articular rheumatism followed by a fever, the temperature 
reaching 102°. The patient during the fever was decidedly 
rational and after recovery from rheumatism fully recovered 
from mental disorder. An epileptic dement from the age 
of ten, was attacked by rheumatism. During rheumatic 

■Rod InoaiMne before ihe Chlcneo Academy of Medicine. 
[28) 



,db,GoogIc 



Interaction of Somatic and Psychic Disorder. 29 

fever the patient was rational but rather juvenile in ideas. 
Soon after recovery he resumed his usual dementia. 
Whitcomb reported a similar case the recovery in which 
was permanent. A paranoiac was attacked by rheumatism, 
during the progress of which delusive ideas entirely dis- 
appeared but again resumed their sway on the patient's 
recovery from rheumatism. 

Gout has, like other somatic diseases, a fourfold relation 
to insanity. It may cause insanity. It may modify insanity. 
It may cure insanity, or it may be cured (at least as to a 
paroxysm) by insanity. These mental relations of gout 
were very early noticed by clinicians. 

Sydenham noticed that: The body is not the only 
sufferer and the dependent condition of the patient is not 
his worst misfortune. The mind suffers with the body and 
which suffers most it is hard to say. So much do mind and 
reason lose energy as energy is lost by the body, so suscepti- 
ble and vacillating is the temper, such a trouble is the patient 
to others as welt as to himself, that a fit of gout is a fit 
of bad temper. To fear, anxiety and other passions the 
gouty patient is a continual victim whilst as the disease 
departs the mind regains tranquillity. 

Savage reports a case in which persecutory delusions 
and suicidal impulses alternated with attacks of gout. The 
patient was free from mental symptoms when suffering from 
arthritic gout. 

According to Berthier : When gout has a marked 
tendency to the brain and nerves it may, under the 
influence of a predisposition, originate every variety of 
neuroses. Tlw psychoneuroses dependent on the gouty 
diathesis are usually metastatic or alternating but some- 
times it predisposes to a latent or larvated psychosis. 
Gouty insanity is often associated with anomalous gout. 
Sometimes the gouty symptoms become lost in the insanity 
which becomes incurable. 

L. C. Gray, in discussing the nervous symptoms of 
lithaemia, points out that brief attacks of melancholia as well 
as suspicious, irritable querulent states may result from that 



jdbyGoOglC 



30 Jas. G. Kieman. 

cause. Similar observations are made by Haig, SpJtzka and 
Wiltrout. Watson corroborates Sydenham in regard to the 
influence of gout on the mental state and points out that 
strong mental emotion may cause the disappearance of gouty 
symptoms. He cites the case of an old man unable to walk 
because of a gouty arthritic enlargement who had an antip- 
athy to rats. The ceiling above his head suddenly broke 
and poured down a fine colony of young rats. He rose sud- 
denly in high dudgeon and walked about angrily but found 
that his gout had disappeared. 

One case of my own which resembles in its chief features 
the acute confusional insanities is as follows: Case I. The 
patient was a descendant of fox hunting, hard drinking Irish 
squireens. He was markedly good-natured and had at 
irregular intervals attacks of gout. The time I saw him he 
was wildly excited dashing around the room, smashing 
articles of furniture and seeking to escape from imaginary 
enemies. Up to within three weeks previous to my visit 
he had been in his usual health but was then attacked by 
gout. While still suffering from this and with his foot 
incased in a shoe open at the toes, he incautiously went 
into a rainstorm. On his return home, the joint swelling 
had vanished, but he was irritable, peevish and loudly 
complained of the noisy streets and his unquiet children; 
one of whom he beat severely contrary to his usual custom. 
His wife described what were evidently visual hallucina- 
tions which were succeeded by the condition in which I found 
him. Under the application of warm fomentations to the 
lower extremities, the gouty swelling returned and yielded 
to conium, colchicum and potassium Iodide, whereupon the 
patient regained his usual mental state. 

While, as Dr. Ray remarks, the insanity of a prince 
has no more importance medically speaking than that of 
a peasant still the insanity of the latter concerns 
immediate relations only while the insanity of the former 
may affect the welfare of great nations. Dr. Ray made 
the observation just quoted anent the insanity of George 
III. George 111. was a congenital paranoiac whose Insane 
taint was due to his crazy ancestor Ernest the Pious 



jdbyGoOglC 



Interaction of Somatic and Psychic Disorder. i\ 

who like himself had an atavistic taste for the primeval 
science of the universe, theology and a primeval art, 
music. George III. was born prematurely at seven months. 
He was in many respects a backward child and was 
peculiarly religious, egotistical, selfish and ungrateful. His 
shrewd grandfather pronounced him good for nothing except 
to read the bible to his mother. His delusions and periodi- 
cal attacks of insanity have been discussed by Dr. Ray at 
length and while of much interest clinically are not of equal 
value from a medical-liistorical standpoint. The paralucid 
period between attacks was the time when his influence 
on the fortunes of mankind was most demonstrable. 
Macaulay has, in many of his essays, depicted the moral 
imbicility of these periods but their dangers are more 
demonstrably evident in the epoch of the American revolu- 
tion when the gouty eclipse of the intellect of the great 
statesman Wm. Pitt, the elder, flung all power into the 
king's hands. 

The mental phenomena manifested under the influence 
of gout by one of England's greatest statesman, William 
Pitt, soon after the repeal of the Stamp Act had no little 
influence in all probability on the future of the race. The 
elder William Pitt, the idol of the American colonists whom 
he had protected against the F/ench and Indians and whose 
views as to taxation he had adopted and supported, became 
insane from gout at a very critical period of his own career 
and of the relations of Great Britain to America. The 
Stamp Act had been repealed, Pitt's policy had triumphed 
and his policy was the correctness of the view adopted by 
the Americans anent the unconstitutionality of the Stamp 
Act. He formed a ministry and then became insane, in a 
manner described by Macaulay in his inimitable pellucid 
style. Pitt's insanity led him to fall into the snares of 
that cunning paranoiac, George III. Pitt at this time was 
as eloquent as ever, and no one suspected him of mental 
disorder, but his habits became more and more eccentric. 
A horror of loud sounds grew upon him. Though the most 
affectionate of fathers, he could not bear to hear the voices of 
his children and laid out great sums buying up houses adjacent 



jdbyGoOglC 



32 Jas G. KUman. 

to his own at Hayfs. merely that he might have no neigh- 
bors to disturb him with their noise. He then sold Hayes 
and took a villa at Hampstead where he again began to 
purchase houses right and left. At Burton Pynsent he 
ordered a large extent of ground to be planted with cedars 
which had to be collected all over England and were, by 
liis orders, planted by torchlight. No man was notoriously 
50 abstemious as Pitt, yet at this time, the profusion of 
his kitchen was the marvel of epicures. Dinners were 
always dressing, as he had a capricious and fanciful 
appetite and when he felt inclined to eat, everything must 
be on the table. As Macaulay remarks, in the true spirit 
of an alienist, setting an example which could be followed to 
advantage, by both lawyers and physicians, other circum- 
stances could be detailed, which, separately and singly, 
were of little moment, but, combined and contrasted with 
surrounding circumstances, and with Pitt's previous and 
after character, justified a diagnosis of insanity. While in 
this fit of planting, Pitt was summoned to form an admin- 
istration, and his notes to his colleagues in posse were so 
arrogant that even the despot, Louis XIV,, became melancholy, 
irritable and fanciful. The state of public affairs was 
embarrassing; his colleagues were in constant dispute, his 
opponents were clamoring against him, yet he, the clear 
headed statesman, the man of whom Frederick the Great 
said, "England has been long in labor but she has brought 
forth a man," whined that he could be saved from all 
these misfortunes only by repurchasing the house he had 
so capriciously and hastily sold. This fancy accomplished 
he was somewhat easier, but when business was mentioned, 
Pitt, the energetic ally of Frederick the Great, the dictator 
of Europe, trembled and burst into tears. He passed 
twenty-one months in gloomy seclusion while his colleagues 
carried out the measures proposed by that morally imbicile 
paranoiac George 111. under, as it were, Pitt's sanction but 
in total contradiction of his policy and wishes. During 
this time American colonies were taxed in defiance of Pitt's 
stirring d<!nunciation of even the theory of such practice 
but even this could not call him from his morbid seclusion. 



jdbyGoOglC 



Interaction of Somatic and Psychic Disorder. 33 

He at lengtli resigned his office. Nine months thereafter 
the gout reappeared and with it Pitt's intellect. He was 
once more buoyant, hopeful and self-confident, but his 
attack of insanity had, as Macaulay says, enabled the 
government formed by him to violate every principle of 
foreign, domestic and colonial policy dear to his heart. It 
is by no means improbable that but for this attack of insanity 
the colonial relations of the United States to Great Britain 
might not have been severed. 

Ben Jonson also suffered from the mental symptoms of 
gout and had periods of depression, irritability and abstrac- 
tion and hallucinatory attacks when he saw Carthaginians 
and Komans fighting in great numbers, bloody battles 
around his gouty great toe. 

Melancholia has recovered permanently after acute 
peritonitis secondary to pelvic haematocele. Melancholia 
has recovered after being attacked by a delirium resulting 
from erysipelas. A paranoiac with hallucinations of hear- 
ing voices through the telephone and depressing systematized 
hallucinations, improved. Paretic dements are often markedly 
improved by erysipelas. An idiot suffering from blood- 
poisoning gave evidence of his rememberance of things of 
which at the time of their occurence, he had been apparently 
oblivious. Old dements become rational during the excited 
period of typhus but sink into their usual condition on 
recovering. The same fever exerts at times beneficial 
influence on cases of acute mania and melancholia. 

Typhoid fever favorably influences one third the cases 
attacked by it. Measles exerts a favorable influence on 
insanity. Patients often improve on being attacked by 
icterus and sometimes recover. I have seen ten cases in 
which improvement followed upon an attack of acute 
pneumonia. The improvement in all began during the 
hyperpyrexia. In two cases acute nephritis apparently 
initiated recovery from melancholia. Patients with melan- 
cholia attonita attacked by acute dysentary often become 
very rational during the continuance of the disease, but 
relapse Into the old condition on recovery from the dysentery. 

Cholera ^s a rule exercises similar influence on coexist- 



ed byCoOglc 



34 Jas. G. Kieman. 

ent insanity. Asthma alternates witti insanity. Rheumatism, 
traumatism and insolation at times change the type of the 
psychoses. Of the effects of variola on insanity; sixty-one 
cases have come under purview. Fourteen recovered from 
insanity on recovering from variola, eight were improved, 
twenty-eight were unaffected and eleven died. Chatelain 
reports thirteen cases in which insane patients were attacked 
by small -pox. A case of emotional insanity remained 
unaffected by a light attack of variola which was also the 
case with a placid dement. A querutent case of emotional 
insanity who suffered from a severe attack of variola was 
unusually docile during the disease. A case of paranoia 
with delusions of suspicion became worse during a light 
attack of variola. A case of emotional insanity improved on 
convalescence from a severe form of variola but relapsed on 
recovery. Three placid dements were unaffected by a light 
attack of variola. Three cases of melancholia which suf- 
fered from a severe attack of variola improved during 
febrile state and one ultimately recovered. Melancholia and 
mania have recovered in consequence of, and after a severe 
attack of, variola. Paretic dementia is said to have been 
cured by variola. 

During the year 1877, small-pox made its appearance 
in the New York City Asylum for the insane among the 
work-house population, one patient had to be removed to 
the smalt-pox hospital in consequence. This patient, a case 
of chronic confusional insanity, died there after some weeks 
illness during which he was completely rational. 

Calastri suggested as a means of determining whether 
the influence of variola on insanity was due to the variola or 
to the suppuration arising from it, that the insane should be 
vaccinated and the effect on the course of the insanity 
studied. My own results were as follows: There are 
numerous delusions which render vaccination difficult since 
the patients believe they could be poisoned by this means. 
One patient indeed evolved the curious delusion that 
his enemies had chosen this means of introducing sper- 
matozoa into his system and thus impregnating him. 



jdbyGoOglC 



Interaction of Somatic and Psychic Disorder. . 35 

Paretic dements, acute agitated and atonic melancholies, 
paranoiacs with depressing delusions, terminal dements and 
hebeplireniacs were vaccinated. The phenomena therefrom 
resulting might be divided into four great classes: First, 
those in which the vaccinia exerted a beneficial effect upon 
the pre-existing insanity; second, those in which it un- 
favorably influences this; third, those in which dangerous 
complications resulted and, finally, those exceptional cases in 
which dermic phenomena were present. 

The pjychoses in which the vaccination exerted the 
most marked favorable influence were melancholia attonita 
and agitata, paretic dementia, rarely in acute melancholia, 
paranoia and secondary confusional insanity. In all of the 
cases wherein such influence was exerted the vaccination 
was followed by a high fever and marked general constitu- 
tional disturbances. There was a pretty general eruption 
resembling variola. On the fever subsiding (in at least 
ten cases it reached 102") the patient having melancholia was 
found to be much more cheerful. Occasionally delusions of 
persecution seemed to be temporarily in abeyance. These 
patients permanently recovered and as they had exhibited 
no change previous to the vaccination it is probable that 
this exerted a marked influence. The paretic dements 
were attacked by boils soon after recovering from vaccina- 
tion and were for a short time rational, but the physical 
symptoms of the disease remained unchanged. The agitated 
melancholiacs were quiet and cheerful during the constitu- 
tional disturbances from the vaccination but after it had 
passed away, all four returned to their usual condition. 
These itnproved and finally recovered. Paranoiacs were 
markedly quiet and relatively rational during the vaccinal 
fever. Secondary confusional lunatics talked coherently 
and relevantly during vaccinal fever but resumed their 
usual condition on recovery. 

In a large number of cases the vaccination exerted a 
decidedly unfavorable result. Delusions of infection with 
syphilis, of loss of identity, of paralysis, of poisoning and, 
in several cases, of infection with smali-pox, were found 
after vaccination. In paretic dements, certain trophic 



jdbyGoOglC 



36 Jas. G. Kieman. 

changes mike their appearance. The toe nails sometimes 
drop off, Haematoma auris occurred during the vaccinal 
fever. In a case of syphilitic paretic dementia the luetic 
affection seemed to take an malignant type. Melancholiacs 
with markedly deficient capillary circulation suffered from 
gangrene of the toes and fingers in consequence of vac- 
cination. There were formed on paretic dements, large 
bullae which subsequently gave way to ulcers of a very 
indolent type. In paretic dementia, apoplectiform attacks 
came on during the vaccinal fever, and large abscesses often 
made their appearance after vaccinal fever to subside on 
the seat of the pre-existing vaccinal eruption. The hair of 
paretic-dements became gray on one side of the head while 
eruption from vaccinia remained confined to the opposite 
side of the body. Melancholia complicated by phthisis 
seemed to be disastrously influenced as regards the pul- 
monary affection which had been previously running its 
course without marked febrile disturbances but thereafter 
had marked rises of temperature. Melancholia sometimes 
displayed symptoms of diabetes mellitus which, however, 
vanished on recovery. 

Dermic phenomena displayed by the patients during 
the existence of vaccinia were very varied. In some cases 
the eruption (which in ninety was generalized) displayed a 
tendency to appear in patches of two or three pustules. 
In others there was a tendency of the eruption to follow 
the course of a nerve. In a few cases the former places of 
vaccination exhibited pustules which began soon after and 
ran about the same course as the pustules of vaccination. 
Judging from these results, variola per se would exert an 
influence on insanity. 

Addison's disease, when it complicates insanity exerts 
a depressing influence on the patient's mental state. In 
paranoia in which it made its appearance years subsequent 
to the original psychosis, the patient manifested true 
melancholtac delusions. It has not yet been demonstrated 
that Addison's disease does more than complicate insanity. 
An etiological relation is not yet established. Personally I 
am inclined to believe that Addison's disease is secondary 



jdbyGoOglC 



Interaction of Somatic and Psychic Disorder. 37 

to the insanity it complicates in tlie great majority of cases. 
Insanity complicated by Graves' disease presented depres- 
sion foreign to its general nature. 

In the insane, rise of temperature, coughs, etc., are 
not infrequently absent and accidental examination often 
reveals an unsuspected extent of pulmonary mischief. 
Phthisis renders paretics more or less suspicious. Far 
advanced phthisis often comes unexpectedly to a standstill 
and is succeeded by insanity whereupon the constitutional 
symptoms of phthisis disappear. When the patient recovers 
from insanity the phthisis runs its usual course. Dr. Jas. 
Macdonatd remarks this in the case of Guiteau's paternal 
uncle who died in the Bloomingdale asylum in 1819. Dr. 
Macdonald had noticed previously this relation between 
phthisis and insanity especially in hereditary cases. Insanity 
in which refusal of food is a prominent symptom is very 
frequently complicated by phthisis. 

The life of the poet Keats* contains so much illustra- 
tingthe mental effects of phthisis that Kossetti, his biographer, 
is continually puzzled by them. The father of Keats was a 
stableman of bookish tastes. He seems to have been a 
natural born gentleman, for even his marriage with his 
master's daughter (Keats' Mother) left him unassuming and 
manly. Keats' mother was pleasure seeking yet saturn- 
ine. She displayed the same emotional mobility and sus- 
plcional tendency which characterized her gifted son. She died 
of phthisis complicated by rheumatism when he was fifteen 
years old. Keats who was her first child, was born seven 
months after marriage. Haydon, the artist, states that Keats 
. was, when a child, most violent and ungovernable. When 
five years' old he once got hold of a naked sword, and 
shutting the door swore that no one should go out. When 
his mother attempted to leave the room, he threatened her 
so furiously that she began to cry and was obliged to wait 
till a man who saw her through the window came to her 
assistance. Keats during his childhood, was irascible, sus- 
picious, querulent and pugnacious. These mental states 



jdbyGoOglc 



38 Jas. G. Kieman. 

alternated with fits of emotional mobility and suspicional 
tenderness. During his mother's illness he nursed her with 
great care and tenderness. 

To physicians the fact is of peculiar interest that Keats 
was apprenticed at the age of fifteen to a surgeon named 
Hammond. Five years later he passed his examination at 
Apothecaries Hall with great credit. In 1816 he became an 
interne- at Guy's Hospital. In 1817 he contracted syphilis 
at Oxford which was successfully treated by mercury. Dur- 
ing the same year he was introduced to Coleridge who pro- 
phesied his early death. In 1818 the first demonstrable symptom 
of phthisis became manifest. He had to leave Scotland and 
abandon his pedestrian tours, partly for this reason, partly 
because of the approaching death of his brother Tom, from 
phthisis. Tom, tilte Keats himself, had been irritable, queru- 
lent and suspicious as a youth. George, the other brother who 
was pacific albeit resolved, long survived Keats. The sister 
who resembled George, died at an advanced age in 1890. 

In September 1818 Gifford's famous critique appeared 
in the Quarterly. Gifford was a fanatical philistinish devotee 
of the mechanical school of poetry founded by Pope. That 
"Endymion",the criticised poem, deserved a severely critical 
analysis is evident from Shelley's remarlt, "I have read 
Keats' poem. Much praise is due me for having read it, 
the author's intention appearing to be that no person should 
'possibly get to the end of it". Gifford's savage onslaught 
was therefore somewhat merited but it had altogether too 
much- of the slapdash abusive style. The Quarterly critique 
had been preceded by a scurrilous attacit on Keats in Blacic- 
woods, by Locltard, Sir Walter Scott's son-in-taw, which 
was revised by the later. -It was characterized by elephan- 
tinely jocose satire (?). The fact that Keats was "Johnny 
Keats", an apothecary's assistant, was the high and 
mighty reason assigned for shutting him out of Parnassus. 

Shelley states, from hearsay however, that Keats was 
driven by the Quarterly critique Into a state bordering on 
insanity which produced the first haemoptysis. The first 
haemoptysis however did not occur for more than a year 
after. 



jdbyGoOglc 



Interaction, of Somatic and Psychic Disorder. 39 

Haydon says: "The effect on Keats was melancholy. 
He became morbid and silent, would call and sit whilst I 
was painting, for hours without speaking a word". Keats 
however had just such attacks of moody, suspicional 
taciturnity before. 

In the preface to "Endymion", flayed so mercilessly 
by Gifford, Keats anticipates "a heli of criticism". This 
being the case the mental effect could not have been so great. 
Moreover the circumstances attendant on the first haemop- 
tysis were opposed to Shelley's opinion. Soon after the 
attack Keats is said to have been excessively addicted to 
claret and to laudanum. All were, however, so soon 
abandoned that they would appear to have been parts of 
some medical treatment tried by Keats. 

The various brief attacks of irascibility described by his 
biographer from time to time taken in conjunction with the 
physical symptoms, must convince any impartial mind of the 
justness of Dr. Richardson's view that Keats' death was 
due to phthisis attacking a frame predisposed to its ravages 
by inheritance. Keats' youngest brother Tom, who trore 
such a decided mental and physical resemblance to him 
died early of phthisis, January, 1820. 

Keats became noted for his moody taciturnity, alterna- 
ting with a suspicion which at times amounted almost to 
panophobia, and became misanthropic, and the companionship 
of friends was tedious. He bewails from time to time his 
increasing lack of fixity of purpose, one of his earliest 
observed defects. The first haemoptysis had been preceded 
by pulmonary symptoms dating from the visit to Scotland. 
It occurred a little over a year after the Quarterly critique 
which, to judge from Keats' letters, does not seem to have 
left a very decided moral impression on him since he did 
not exhibit more than the querulency and irritability, com- 
mon to one of his moods. A year later, however, near 
midnight one evening, Keats, according to Lord Houghton, 
returned home in a state of "strange physical excitement" 
which to those who did not know him, might have appeared 
to be one of fierce intoxication. He had been chilled through 
on a stage coach and soon after his return home spat up 



jdbyGoOglC 



40 Jas. G. Kiemart. 

blood for the first time. His second attack occurred the 
next June, and thereafter Keats was so irritable, querulent 
and suspicious that the accidental opening of a letter by 
one of Leigh Hunt's childrtn caused such impassioned out- 
bursts that he left Leigh Hunt's house despite all apologies 
and remonstrances. 

The "fierce" condition of "physical excitement", which 
Lord Houghton likens to intoxication and which seems to 
have been reported to Shelley as allied to insanity, was 
clearly an attack of emotional exaltation accompanied with 
irritability such as occur among the mental symptoms of 
phthisis. Rossetti is puzzled by the appearance of this 
"physical excitement resembling intoxication" at the time 
of the haemoptysis, but such mental symptom is a far from 
infrequent precedent to haemoptysis which it no doubt often 
provokes. 

A singularly pat illustration of the emotional exaltation 
attendant on the first haemoptysis is to be found in the 
frivolous jaunty satire on George IV. written by Keats at 
this time whose jocose tone under the circumstances puzzles 
Kossetti. 

The following August after phthisis made its appear- 
ance, Keats who had pronounced his own death warrant 
on the first haemoptysis, began to doubt his own diagnosis 
and believed his recovery certain. 

His love letters written precedent to the critique and 
(or some time thereafter are, to quote Kossetti, unbalanced, 
wayward and profuse, full of suspicion from the outset 
which is at first directed toward his friends and finally to 
his adored herself. Keats was well aware of this peculiarity 
of his, for he says; "You have all your life believed every- 
body, I have always suspected everybody." 

September, 1820, Haydon found Keats, then on his 
way to Italy, helpless, despondent, irritable and suicidal. 
December, 1820, he was delirious part of the time and had 
excessive longing for food. His mental condition varied. 
He was subject to unsystematized grandiose delusions 
accompanied by suspicional irritablility and followed by 
quiet stupor. He died February 23, 1821. 



jdbyGoOglC 



Interaction of Somatic and Psychic Disorder. 41 

The prevalence of fashion in medical thoueht is illus- 
trated by the fact that the Irish seventeenth century theory 
of the contagiousness of phthisis still prevailed at that 
time at Rome and the room in which Keats died was treated 
as if an infected person had died therein. 

Taking into account all the circumstances of Keats' 
career: His lack of fixity of purpose, which even Shelley 
found evident in "Endymion". his suspicional tendencies 
described by himself and others, the emotional mobility 
noted by Lord Houghton and others and clearly evident in 
the jocose satire on George IV, his irascibility and pugnacity 
as well as his heredity, the influence of phthisis on Keats' 
mental state is clearly manifest. 

If he had confined himself to the regular routine life of 
the medical practitioner, his Hfe might have been preserved, 
since the emotional alternations of the life of the man of 
letters were certainly productive of vasomotor changes 
stimulating the mental and other symptoms of phthisis, and 
thus producing exhifustion. 

The influence of phthisis on the mental state of Emily 
Bronte is equally demonstrable. Her keenest biographer. 
Miss Robinson, says: "Insanity and genius stand on either 
side; consumption has worse and better angles. Let none 
call it impious or absurd to rank the greatest gift to man- 
kind as the occasional result of an inherited tendency to 
tubercular disease. There are of course very many deter- 
mining causes. Yet it is certain that inherited scofrula or 
phthisis may come out, not only in the diseases, but in 
alternation for better or worse condition of the mind. Out 
of evil may come good or worse evil." 

The father. Rev, P. Bronte, could not be called a 
pleasant easy-going husband and father. He rivaled Car- 
lyle in being "illgey to live with". "How J pity his delicate 
wife who sat lonely and neglected as he was studying or 
when he did not come, bore with patience his stern per- 
emptory manner. He was a passionate brute, cutting her 
favorite silk dress into shreds because he, her lord and 
master, chose that she should not accept a gift. He threw 
the children's pretty shoes in the fire because forsooth he 



jdbyGoOglC 



42 las. G. Kiernan. 

did not fancy the color. Occasionally he would vent his 
beast -like rage by firing pistol shots out of doors. A 
gnion of this semi-insane temperament and consumptive 
constitution of his wife certainly produced genius tinged 
with sadness". 

The history of the two Bronte sisters certainly affords 
abundant evidence of the mental symptom associated with 
phtliisis observable in Keats. 

One lesson stands out prominent from these facis, the 
mental symptoms of phthisis are caused by and cause 
physical unrest. The interaction of these two factors tends 
to accelerate the progress of the disease and, by increasing 
the physical exhaustion of which they are the expression, 
to decrease the chances of recovery. The mental condition 
of phthisis therefore needs as much attention as the physi- 
cal. To calm the restlessness of the phthisical is there- 
fore to add one factor toward recovery, Aiitipyrin in small 
doses has been found by Clevenger to be of value in this 
direction, 1 have found acetanilid conttaindicated but have 
noted that phenacetin exerts a beneficial influence. Loomis 
is of the opinion that these drugs owe their influence in fever 
less to their antipyretic power than to their influence on 
the excitability of the nervous system. This excitability is 
present in all mental conditions attended by suspicion. The 
moral treatment of phthisis is no less likely to be of value 
than medical treatment. The fact should also be remem- 
bered that the precocity of these phthisical and scrofulous 
children, is a symptom of disease likely to result in 
mental and physical break-down ere the period of puberty 
be past. 

(To be Continued.) 



jdbyGoOglC 



IMPERATIVE CONCEPTIONS. 



A Note by C. H. HUGHES, M. D. 

THE insane display with their delusions many morbid 
states besides, some of which are clearly comprehended 
by the general practitioner and some are not, and even the 
mind of the skilled psychiatric clinician and experienced 
student of medico-legal alienism, is not always clear upon 
all of these states. Among the data of Alienism the morbid 
impulsions of the homicidal, suicidal, pyromaniacal, klepto- 
maniacal and the perverse inclinations and acts of the 
reasoning or affective insane are well enough known to 
psychiaters. These, as well as singular aversions and freaks of 
speech, feeling and conduct, are recorded in the literature of 
insanity. But the imperative conceptions of the insane inde- 
pendent of delusions as evidence of mental unbalance were 
questioned in the Guiteau trial and are still doubted by 
some eminent authorities. 

The following auto-description sent me by a patient 
whom I have had under treatment will settle this question. 
Impulsions to suicide and extreme melancholia atonita have 
coexisted in the history of this patient who is now much 
improved as to these mental states, and it may be premised 
that she descended from an irreproachable and upright ancestry, 
being the daughter of a distinguished English-speaking 
divine noted for his probity and piety, and she herself is 
a christian church member, hitherto noted for her religious 
fervor and zeal and indefatigable church work. 

Here is the record so far as I may give it without 
disclosing too much of the personnel of the patient. 
[43] 



jdbyGoOglC 



44 C. H. Hughes. 

M— A. 
Dr. Hughes: — I write to know if you thought it would 
do me any good to take medicine at home, that is, if you 
can send me some without me going to see you. 1 am 
not well by any means, and yet 1 am not sick. You said 
for me to quit swearing. I can't, would that I could. I go 
about my work crying and talking. I will say, "well I just 
will not do that any more," and it will not be five minutes 
until I will be at it again. It seems to me I have done 
awful deeds and they follow me, or that I am possessed of 
evil spirits and can't get rid of them. I think and say such 
awful things. ! never did so before, and do not believe ! 
want to now. It is not convenient for me to go to St. 
Louis so often, and I do hate giving up being cured. If you 
will oblige me, write and tell me what you think. Direct tu 
Itt. M. A. 

When such imperative conceptions pass the boundary 
line of normal restraint into the uninhibitable realm of 
mental aberrations and become resistless expressions and 
acts violative of the proprieties and normal restraint 
of environment and have a recognizable disease for their 
basis, we class them as evidences of insanity. The mental 
state is that of insanity, and the condition is only a ques- 
tion of degree, for here is ill health affecting the brain and 
a change of natural character out of harmony with natural 
self and environment as a consequence, and this is true 
menial aberration. 

One of my office patients while engaged in business 
came to me expressly to be relieved of a conception and 
impulse to kill a certain person in his employ. He had 
insomnia, cerebrasthenia and apepsia nervosa. When 
relieved of these nervous conditions, he recovered. Some 
years subsequently he actually attempted to kill one of his 
men, for which he was arraigned and taken into court. He 
was not under treatment at the time. 

Recurring morbid conceptions and frequent impulsions 
to suicide are often observed in every neurologist's practice, 
certainly they are very frequent in mine. 



jdbyGoOglc 



Imperative Conceptions. 45 

Enough significance is not attached by the general 
practitioner to the imperative conceptions and morbid impul- 
sions of cerebrasthenic dyspepsia. They are not so frequent 
as the phobias, but they do exist in some patients and 
will be revealed to us if vire inquire closely of the psycho- 
pathic cases. A volume might be written in illustration of 
the many forms of imperative conceptions and impulsions 
of the actively neuropathic, but to enumerate them is not the 
intent of this article, but simply to illustrate the nature of 
the imperious conception which so often precedes the recog- 
nized outbreak and overt act of insanity. 

Wigan, author of "Duality of the Mind", who was 
an acute observer, as well as an ingenious theorist, called 
these cases "madness of volition", "a state of mind so 
common", he says, "that no person at all conversant with 
the management of the insane but must have met with 
many instances". He could enumerate many examples of it, 
"the most remarkable of which", he gives the following, 
which by the way is a case of true folie circulaire of the 
French, the cyclothemia of Kohlbaum: 

"1 was once visiting at a very respectable establish- 
ment for persons of deranged intellects of the upper class, 
when the house was suddenly disturbed in the middle of 
the night by the violent noises and language of a young 
gentleman who had been long an inmate, and whose dis- 
ease assumed a character of periodicity. There was a kind 
of cycle, beginning with intense despondency, passing on 
to composure, to cheerfulness, hilarity, ■ boisterous gaiety, 
violent and convulsive mirth, extravagant volubility 
and wit, gross and monstrous obscenity, incoherence, and 
thence into the most furious mania, requiring coercion. 
This gradually subsided into melancholy, left him two or 
three weeks in a state of tranquility, and then went again 
its miserable round. On the present occasion the patient 
insisted on seeing the head of the establishment, but as he 
was manacled by both wrists to the bed, it was not thought 
necessary to comply with his demand. The violence of the 
efforts he made and his furious screams, at last alarmed 
the attendants lest he should break a blood-vessel, and the 



jdbyGoOglC 



46 C. H. Hughes. 

gentleman was called out of bed. On approaching the 
patient, who had become instantly calm when told that the 
doctor was called and would come to him, he said, 'What 
is the reason of this disturbance, sir; and why am 1 called 
out of bed at this unreasonable hour?' 

" 'Don't be angry, doctor', was the reply, 'I wish to 
tell you that 1 can get my hands at liberty. You see how 
small they are. You must send to the ladies' establishment 
for a smaller pair of manacles.' 

" 'There is no danger of that, sir; you are perfectly 
secured; lie quiet and go to sleep.' 

"In vain did the patient urge with increasing violence 
the necessity of securing himself more firmly. The doctor 
refused; when the young man succeeded in extricating one 
hand and gave him a violent blow — 'Do you believe me 
now?' said he. 

"This was an irresistible argument; a pair of ladies' 
manacles were sent for, and securely fastened. The patient 
pulled in all directions for some time, and finding himself 
quite unable to get his hands out, said, 'All right now 1 
am quiet. While I knew that there was a possibility of 
extrication I could not restrain my propensity to kill some- 
body. I am sure I should have done it, though I tried so 
hard to prevent it. Now that I know myself secure, I am 
quiet. Now do, my dear doctor, sit down and have a little 
chat with me. ! have thoroughly waked you up, and it will 
be charity to bestow half an hour on me.' 

"The gentleman told me that his conversation was then 
exceedingly witty and agreeable, and that only on a few 
occasions did he utter any incoherent expressions, and those 
only when the conversation flagged and he seemed to be off 
his guard. 

"The next day he had his usual paroxysms of violence, 
passing on into furious mania."* 

Wigan's explanation of the mental phenomenon we are 
considering in accordance with his theory of the mind, was 
on the supposition that one of the brains(hemispheres} was 

• Duilliy ol Mind. 1844, p. 286-7-8. 



jdbyGoOglC 



Imperative Conceptions. 47 

in vain endeavoring to control the other which was going 
wrong, "felt its authority slipping away" and desired the 
aid of more positive restraint from without. In our case, 
medical restraint; in his, that of wristlets. 

These imperative conceptions and morbid impulsions 
without definite delusion at the time, are quite common and 
characteristic of circular insanity and paranoia, but it is not 
so often we find them as in the subject of this paper, un- 
associated with well defined mania without delusion. 

Nor do we find them associated with melancholia with- 
out delusion, as in this case, the patient's melancholia being 
a sequence, and a rational one, of the imperative concep- 
tions. 

A very genteel victim of the invisibles and voices now 
coming to my office has, along with his auditory hallucina- 
tions, imperative conceptions of a loathsome character 
which he shamefully confides to me. His abnormal cere- 
bral condition about the sight and auditory centers of his 
brain is a sequel of typhoid fever, from which he con- 
valesced four months ago, afterward vainly seeking relief of a 
Christian scientist from the annoying voices. Irresistable 
imperative conceptions of the auditorily hallucinated often 
appear as the most prominent evidence of grave insanity, but 
in proof that imperative conceptions and apparently resistless 
impulsions are not per se evidences of insanity, the case 
we record, as well as the history of Ben Johnson's impul- 
sive habit and peculiarity of touching and counting the 
palings of a certain fence so often passed by him, with 
many others, is confirmative. 



jdbyGoOglc 



DEFENCE OF MODERN PSYCHIATRY. 

By DR. WM. HIRSCH, New York. 
Mrodiution to " G*nius and Dtgtntralion." 

rjSYCHIATRY, or the science of mental diseases, is one of 
■ ■ the fruits of the century now drawing to its close. It 
was only in 1792 that Pine! struck the fetters of the patients 
at the Bicetre and began to treat them humanely; and as late 
as 1818 Esquirol reported to the ministry that criminals, not 
to say brutes, were better treated in France than were the 
insane. The progress of this youthful science within the last 
decades may, however, be contemplated with some degree 
of satisfaction, and with a strong confidence that the stream 
of knowledge will be poured out in still fuller volume in 
the years to come. 

Maturer studies and better-reasoned treatment are grad- 
ually enlarging the class of mental disorders that are cura- 
ble. Society has also to thank modern researchers into the 
causes — the etiology — of those diseases. By this study we 
are enabled to oppose the production and spread of those 
maladies; and general information about their causes will 
directly contribute to the well-being of the community. 

Derangement of mind has in all ages had no inconsider- 
able influence upon the course of history and the develop- 
rnent of civilization; there is much in society that is men- 
tally unwholesome and many crazes tliat psychiatry can 
show how to avoid. That insanity is a disease of a particu- 
lar organ, biologically indistinguishable from a somatic dis- 
order, was, in former times, not understood. The notion of 
madness was mixed up with religions, faith and metaphysical 
theories. Thousands were burned at the stake simply 
[48] 



jdbyGoOglc 



Defence of Modem Psychiatry. 49 

because men were not so far enlightened as to recognize 
that their victims were mentally sick, instead of being, as 
they imagined, bewitched or possessed by the devil. Think, 
too, of the multitudes of entirely sane and innocent persons 
who were sent to the rack and the stake upon the accusa- 
tions of madmen — mere crazy delusions! Along with such 
dreadful results of ignorance, and contributing to them, we 
find, in ages widely separated, men's general conceptions of 
the course of nature influenced by superstitions and relig- 
ious enthusiasm fostered by the behaviour of the insane, 
and accepted largely in deference to teachings of bewildered 
minds. 

About the end of the eighteenth century the sad veil of 
superstition began to be lifted. Yet the pathway of knowl- 
edge was still a thorny and difficult one. Many an obstacle 
remained to be removed. Many a hot fight had to be fought 
out. Often and often, even in the nineteenth century, 
theologians set their traps to render the scientific pathway 
personally perilous. Even as elevated a mind as Heinroth 
declared that the cause of insanity was sin. 

Alienists to-day no longer regard mental and bodily 
maladies as distinct. In the majority of bodily diseases some 
affection of the mental powers is observable; so that no 
scientific physician will overlook the importance of psychical 
influences. On the other hand, bodily symptoms occur in 
by far the greater proportion of cases of insanity. We can 
sometimes predict a severe and almost fatal derangement of 
the mind at a time when hardly any aberration has yet 
appeared, on the strength of somatic symptoms that no 
ordinary person would remark. Thus, mental and bodily 
disease are quite inseparable; and a rational treatment of 
psychoses must be based upon a solid foundation of general 
medical skill. 

In spite of all these facts, attempts are still made to with- 
draw the care of the insane from the hands of physicians 
and to intrust it to the clergy. At a meeting of the Ger- 
man Union Evangelical Curates of the Insane, the Rev. 
von Bodelschwingh, while admitting that "modern medico- 
scientific psych atry had done good service in the recogni- 



jdbyGoOglC 



50 H^m. Hirsch, 

tion, treatment, and cure of insane," yet censured it as 
at bottom materiallstii: and temporal." "It leaves," he 
said, "sin and grace, conscience and guilt, quite out of 
sight, and does not recognise that forgiveness of sins brings 
life and spiritual health." Hecontinued as follows; "Speak- 
ing broadly, the less the bodily physician uses his materia 
medica in mental maladies, the better. Such things, for the 
most part, only damage body and soul. The bodily physician 
may be helpful in the care of the insane, but the prime 
thing is the treatment of the sick soul; and this should 
not be intrusted to the physician in the main."* 

Such utterances are, of course, merely the efforts of the 
clergy to extend their power. But inasmuch as they tend 
to injure patients, not to say society itself, the interests of 
civilization call upon men of science to combat them. 

Nor is it by the clergy alone that attacks upon psychiatry 
are made. Various causes have conspired to create of late 
years some distrust of this branch of medicine. The gen- 
eral public is naturally liable to misinterpret cases of 
insanity in which the symptoms are not so obvious that no 
onlooker can mistake them, and where the practiced eye 
of the specialist is required to detect their real nature. 
Then, too, the not infrequent differences of opinion among 
experts in insanity, leading, as they often do, to contrary 
judgments about the nature of individual cases, are cited as 
so many proofs that psychiatry is an illusory science, and 
that its practitioners are not to be trusted to decide upon 
the fate of a man. 

But this is altogether fallacious. Similar objections 
would lie against any other practical science. Name, if 
you can, the branch of clinical medicine in which doubtful 
cases do not occur, or where divergences of opinion are 
less frequent than in psychiatry itself. No science whatso- 
ever is ;)erfect or infallible. In every field our knowledge 
and skill have their limits, and there are disputed marches 
between the completed conquests of science and the regions 
her armies have not yet invaded. Cases in law, as every 



jdbyGoOglC 



Defence of Modem Paychiaity. 51 

body knows, are continually arising concerning which the 
greatest jurists pronounce diametrically contrary opinions. 
Yet the ideas and terms with which the lawyer has to deal 
are, from the nature of things, susceptible of more rigidly 
exact definition than those which fornn the stock of the 
alienist. 

In point of accuracy, psychical pathology simply stands 
upon the general level of other branches of clinical medi- 
cine. There are cases upon the border line between insan- 
ity and mental sanity, and concerning them differences of 
opinion are unavoidable. But how can that be considered 
to detract from the value of the general science? Mistakes 
occur wherever human judgment has to be exercised. In- 
deed, every remarkable advance of human knowledge is 
secured at the cost of temporary errors. 

The wisdom of early ages burned the insane as witches 
and sorcerers, or, at best, incarcerated them in dismal dun- 
geons and loaded them with chains, Down to the very 
beginning of this century insanity was hardly recognized as 
a branch of medical science. But now the pendulum has 
swung the other way, and there are efforts in many quarters 
to narrow more and more the bound.iries of mental sanity, 
until every mind, decidedly unlike those we daily come in 
touch with, or manifesting any extraordinary characteristics, 
is labelled as diseased. Not only are the less gifted — par- 
ticularly criminals — frequently considered as insane, but 
eminent writers go so far as to pronounce every mind whose 
capacity greatly surpasses the average to be a pathological 
subject. 

Such doctrines are examples of a class of errors which 
frequently arise from the gradual modification of the mean* 
ings of scientific terms that had never been distinctly appre- 
hended. Among such terms are those of Genius and De- 
generation; and to analyze these conceptions is the purpose 
of this work. Their psychologicdl and psychiatric signifi- 
cations have, as we shall find, been most diversely con- 
ceived, and this has lead to many misunderstandings. 



jdbyGoOglc 



CYCLONE NEUROSES. 



By C. H. HUGHES, M. D., St. Louis. 



I HE neuropathic aftermath of the devastating cyclone 
which swept over St. Louis is now to be gathered in 
the histories of the mentally maimed and neuropathically 
wounded; not alone among those who, bereft of fortune 
and friends deceased, but among the direct victims of fright 
and shock. 

In relation to this particular visitation of nature's awful 
violence, we may call them the neuroses of the great cyclone, 
but the neuropathic manifestations are much the same as 
those which have followed in the wai<e of other great violent 
visitations, such, for instance, as have followed (but have 
not been so well recorded as they are in our day of 
advanced neurological l<nowledge), after wars alarms, the 
carnage of actual battle, the murders, rapine despair and 
desolations of hearts and homes that follow advancing, 
contending and retreating armies and the pestilence that 
walks in mysterious devastating ways, revealing the noon- 
day destruction. 

Chorea, or the dance of St. Vitus, and the insanities of 
revolutionary epochs are too familiar to be worthy of renewed 
extended record. They have filled many pages of the 
world's history and have marked the track of every great 
hurricane, as they follow great fires, riots and social 
upheavals. The neuropathically endowed, the inherently 
neuriatrically inclined are then preferred victims, but even 
the neurally stable nervous organizations may be so strained 
by these potent causes of psycho-neural shock as to be, 
[52J 



jdbyGoOglc 



Cyclone Neuroses. 53 

for the first time in the individual or family life history, 
strained beyond stable recuperation. 

We have noted, however, but few of the latter that we 
could verify with absolute certainty. 

The viscera innervated by the vagus nerve, as well as 
the brain from which it takes its origin, and the whole 
cerebro-spinal axis have to our observation chiefly displayed 
the effect of the cyclone's shock, as in the sequellae of 
that toxic neurosis which but lately so puzzled the profes- 
sion. La. Grippe. 

Among my cases, excluding several mental aberrations 
and chorea without symptomatic signs materially different 
from insanity or chorea from other causes, have been several 
cases of tachycardia, rythmic and arythmic, two of which 
still persist and one, a lady of forty-eight, who had passed 
her menstrual climacteric and recovered from all of its 
incidents and sequellae with steady heart's action, though 
she had the rheumatic diathesis and had been under many 
years' surveillance and prophylactic treatment, was riding in 
her carriage homeward from one of the stores down town" 
at the beginning of the big blow. 

On her way she encountered falling wires and flying 
timbers, the coachman courageously managing his horses but 
meeting with dangerous obstructions and meeting with a 
hair-breath escape from a runaway team, finally reached a 
place of safety for the ladies in a low building and a place 
of shelter for himself and horses. But the green, black 
clouds, sweeping whirlwind, the falling trees, poles and 
wires and surrounding reign of terror made its ineffaceable 
impress upon the lady's brain and nerves. 

She came under treatment for rapid tachycardia, insom- 
nia and psychical symptoms of apprehensive dread at the 
mention of the great calamity. Neural and psycho-neural 
quiescence therapeutically induced and properly maintained 
with treatment adapted to the restoration of neural stability 
and recuperation has brought about a fairly normal state but 
the heart has settled into an apparently permanent condi- 
tion of arythmic tachycardia with normally strong impulses 
and the capacity of compensation under ordinary mental 



jdbyGoOglC 



54 C. H. Hughes. 

or physical effect, so that the lady now discharges the least 
laborious of her former household directing duties and carries 
the lighter cares of domestic life without great burden. 
Digitalis, artificial digestives, neural tranquilizing agents, 
neural and haemic reconstructives, with suitable atten- 
tion to the physiological state of the vital viscera epitomizes 
the therapeutic management, while discussicns or details of 
the cyclone were prohibited and the range of mental strain 
and worry was limited, and tiie psychiatry of her environ- 
ment was made as psychologic as practicable. 

The anxious anticipation of a recurring cyclone with 
every cloud that appeared or wind that blew was a mental 
feature for this and all the other cases. 

The other grave case recovered entirely, as did some 
others of minor degree, being less damaged neuropathically. 

Two peculiar forms of inspiratory spasm, not suchashave 
been described by Ross, that most practical and complete 
of all hngiish neurologists in the description of certain forms 
of non-classical neuroses, also came under my observation 
and treatment. 

The spasm described by this writer "consists of a more 
or less rapid succession of deep inspirations, while the 
expirations are performed in the usual noiseless way" with 
or without singultus. In Ross' cases "the chest is pow- 
erfully expanded, the epigastrium is protruded, the auxiliary 
muscles of respiration are excited to action, the pectoral and 
sterno-cleido- mastoid are brought into strong relief, the 
shoulders are raised, the head is drawn backward and the 
respiratory muscles of the face, alae nasi and eyelids enter 
into strong contraction. Inspiration is noisy and often 
accompanied by expirations of gas from compression of the 
stomach. The spasm usually occurs in paroxysms of variable 
duration, the abdomen is generally tympanitic and there 
are, as a rule, other symptoms of nervous derangement, 
especially those characteristic of hysteria." 

The symptoms in my cases were not exactly similar or 
so numerous or aggravated. They were states of vago- 
phrenlc arythmia — disordered vagus innervation. 

Miss is a young lady from the East side, living 



jdbyGoOglc 



Cyclone Neuroses. S5 

out of the range of the Cyclone's greatest damage but not 
out of sight of it, who after it had passed came into East 
St. Louis to see the ruin it had wrought and learned of the 
sudden injury and death of many of her intimate young 
friends. The effect upon her was to produce a sort of 
choreic hysteria, insomnia, loss of appetite and diaphragmatic 
spasm and an expression of anxiety and fright. The chorea, 
loss of appetite and insomnia soon disappeared under 
treatment leaving the anxious frightened expression and 
disturbed respiratory rythm. This was much like a Cheyne- 
Stoke's breathing at first but became more regularly irregu- 
lar than the latter, finally settling into regular, slow and 
jerky inspirations numbering from twelve to fourteen to the 
minute. There was no thoracic pain but some dyspnoea at 
first. These, under digitalis and pepsine, ammonium 
bromide, hypophosphites, strychnia and arsenic, securing 
adequate rest and nutrition to the respiratory centers and 
the brain cortex, gradually came up to the normal standard 
— eighteen respirations per minute — while the pulse beat 
which had been accelerated and small, became about normal, 
i. e., from seventy-two to seventy-six beats per minute. 

Anxiety and apprehension left the girl's countenance, 
she improved in flesh and spirits and went home after three 
months' treatment apparently restored. 

A second case similar to this occurred in the person of 
a struggling medical student's wife, the sole cause being 
anxiety and solicitude with the superadded and predispos- 
ing condition of malarial toxhxmia. In this case there was 
only lowered respiratory movement, fourteen to the minute, 
an anxious expression, but no thoracic pain or dyspnoea or 
previous chorea. She is improving on anti-malarial treat- 
ment, and on digestives, arsenic and the bromides. 

This case in juxtaposition serves to show that the so-called 
Cyclone neuroses are simply shock and centra! nerve-strain 
nervous disorders, and might come as well from other causes 
of shock more or less profound to the nerve centers and 
not to unduly magnify the effects of this great cataclysm 1 
may note that numerous lesser neural disturbances have 
come under my professional observation showing cerebro- 



jdbyGoOglC 



56 ■ C. H. Hughes. 

spinal damage among them, cases of paraesthesia, 
hyperaesthesia, analgesia and hysteroidal shock, neuras- 
thenia and some of the so-called traumatic neuroses and 
"railway spine" symptoms such as follow the perceptably 
uninjured after railway accidents. I saw some similar 
nervous states to those witnessed after the great St. Louis 
Cyclone among the women driven from their homes before 
an advancing army during the great American secession war, 
while in charge by medical authority of the refuges at St. 
Louis, from South-East Missouri. 

The same causes which produced premature birth, 
caused nervous disturbances, which I did not so well under- 
stand then as now and could not therefore then so well 
chronicle, being then but a young surgeon of twenty-two 
years of age with rank and responsibilities far above the 
merit of my experience at the time. 



jdbyGoOglc 



On the Effects of Extirpation of the Para- 
thyroid Glands.* 

Notes by PROF. G. VASSALE and Dr. F. GENERALl. 

^INCE our first communication concerning the various 
*-^ consequences resulting from the extirpation of the four 
parathyroid glands (I) we have continued to mai<e, and 
are still prosecuting our studies on this important subject. 
We here present summary of tlie results of several 
varieties of experiments. 

A. Extirpation of both parathyroid glands of one side. 
In four dogs we removed the two right parathyroid 

glands. Two were thus operated on Feb. 22d, the third 
April 17th and the fourth April 24th. Three of these ani- 
mals showed no disturbance whatever; one of the two 
operated on Feb. 22d, presented some disturb;inces during 
the first days after the operation (psychical depres.'-ton, 
rigid walk, tremors and lack of appetite), but these disap- 
peared. At present all four are in good condition. 

B. Extirpation of the four parathyroid glands, those of 
one side being removed at one time and those of the other 
side at a subsequent operation. 

The right parathyroid glands were removed from a small 
dog on Feb. 26th; from this the animal rallied fairly mani- 
festing, however, loss of appetite and of vivacity. March 
2ist he was somewhat emaciated, but in fairly good condition, 
when we removed the left parathyroids. The next day he 
was greatly depressed, presented tremors, rigid and tottering 
walk, and paralysis of the legs. In the following days 

Boyle. Protessot nl Normil and PatholoElcil HIslolocy. Ontario M'dicil CoWtte lot 
Women. Toronto; Phyilclan to Girls' Hom*. Toronto. 
[57] 



jdbyGoOglC 



58 G. Nassau and F. Generali. 

these conditions became worse; the animal died March 26th. 
From two medium-sized dogs we removed March 16th 
the two right parathyroids. The animals recovered from 
this first operation. On March 30th, the two left parathy- 
roids were removed. After eighteen hours in one, and 
forty-eight hours in the other case, they began to manifest 
the characteristic morbid phenomena (dyspncea, rigidity of 
the posterior limbs, tottering walk and muscular tremors). 
The animals became progressively worse in the succeeding 
days, and both died April 12th. The wounds had healed 
by first intention. 

C. Extirpation of the two internal parathyroids. 

A dog thus operated on, April 24th has shown no bad 
symptoms; it has always enjoyed, and has still perfect 
health. 

D. Extirpation of the four parathyroids; the internal at 
one time and the external subsequently. 

On March 30th, we removed from two dogs the inter- 
nal parathyroids of both sides. The animals rallied from 
this operation. On May 1st we extirpated the two external 
glands. On May 2d in one and May 3d in the other, there 
developed the flrst morbid symptoms (anorexia, dyspnoea, 
fibrillary contractions, rigidity of posterior limbs). These 
progressively increased; the one died on the night of May 
19th, the other that of May 26th. Both wounds had healed 
by first intention. 

E. Extirpation o} three parathyroids, both external and 
internal of one side, external only on the other. 

On April 9th and June 10th, respectively we removed 
from two dogs the right internal and external parathyroids 
and the left external. The animal operated on in April at 
several times showed signs of functional insufficiency of the 
extirpated glands (psychical depression, anorexia, rigidity 
of the hind legs, slight dyspnoea, muscular tremors). Since 
June 8th, however, it has been in good condition. The 
one operated on in June has, as yet, shown no disturbance 
of function. 

F. Extirpation at one operation of three parathyroids; 
external and internal of one side, external only of the other; 



jdbyGoOglC 



Extirpation of Parathyroid Glands. 59 

extirpation at a second operation of Ike thyroid lobe contain- 
ing the fourth parathyroid. 

On April 11th, we removed from a small dog the 
external parathyroid of the right side; we could not suc- 
ceed in finding the internal gland. From the left side we 
removed both external and internal. Immediately after the 
operation the animal showed slight depression, but very 
soon recovered completely. On Miiy 21, he was in excel- 
lent condition, very active and much increased in weight, 
when we removed the right thyroid lobe, which should con- 
tain (and in fact the microscopic examination showed it in 
the interior of the lobe) the internal parathyroid. The next 
day it began to manifest morbid phenomena (strong psychi- 
cal depression, rigid walk, paralysis of the masticatory 
muscles and those of the limbs and diffuse tremors). The 
condition became rapidly worse, and the animal, greatly 
emaciated, died on June 2d. The wound had healed by 
first intention. 

C Complete extirpation of the thyroid lobe of one side 
and the external parathyroid of the other side. 

On May 9lh, we removed from a bitch of small size, 
the entire left thyroid lobe, and, at the same time, the 
right external parathyroid. We searched on this side for 
the internal parathyroid, but could not determine its posi- 
tion, and in doing this we disencapsuled and otherwise injured 
the thyroid lobe. Notwithstanding this the animal has as 
yet presented no disturbance whatever. 

H. Extirpation of the thyroid lobes leaving in situ only 
the two external parathyroids. 

This operation has already been performed by Gley 
(2), in support of qujte other views on the glands in 
question. To Gley with his well-known theory of the 
function of these glands, it was not important that they be 
completely isolated. "On fait," he says "la ligature el 
plus prfs possible de la glandule. II import peu, d'ailleurs, 
qu'il reste en deca de la ligatute une petite pOrcelle du tissu 
meme du lobe, puisque de notnbreuses experiences nous ont appris 
qu 'il faut laisser aux chiens opMs au mains le tiers supf- 



jdbyGoOglC 



60 G. yassale and F. Generali. 

Tieur d'un lobe pour qu'ils fchappent aux suites de la 
thyroidectomie ." 

According to Gley therefore the operation was feasible 
in all cases, whatever the disposition of the external para- 
thyroids. We, however, were anxious to have the iso- 
lation of the glands in question quite complete, so 
that nothing could possibly remain of the thyroid lobes. 
We chose only those cases therefore in which the external 
parathyroids had a favorable disposition and could be found 
more or less easily isolated, at tlie superior or inferior extremity 
of the lobe. The dogs on which we made the extirpation, 
making it as complete as possible of the two thyroid lobes, 
sparing the two external parathyroids, having numbered 
four in all. Two were operated on, on May 25th, the third 
on June 10th, and the fourth on June Uth. Of these four 
only one of the two operated on in May, presented any morbid' 
symptoms (slight psychical depression, loss of appetite, 
slight rigidity of the hind legs, some muscular spasms). 
By June 4th, however, it was entirely well; the other 
three showed no bad symptoms after the operation and 
have since remained well. 

/. Extirpation of llie two thyroid lobes leaving in sitif 
only one external parathyroid. 

On May 5th, we removed from a small dog the whole 
right thyroid lobe; on the left side we removed the thyroid 
lobe leaving in situ the external parathyroid. During the 
first week after the operation the animal was somewhat 
depressed, ate little and presented fibrillary contractions 
and some muscular spasms; then he rallied and at present 
is quite well. On June 22d, we removed from a medium- 
sized dog the two thyroid lobes leaving in place only the 
right parathyroid. The dog has shown no disturbances 
from the day of the operation until the present. 

We could not fail to see, having kept the animals 
alive, whether in cases A, C, E, G, H and I there were 
to be made manifest any further morbid phenomena. 
Nevertheless the results of our researches which we have 
briefly presented in these notes, and particulars of which 
will be given in our large work, fully justify the last words 



jdbyGoOglC 



Extirpation of Parathyroid Glands. 61 

of our first article, setting forth the specific functional import- 
ance of the four parathyroid glands. As may easily be 
seen we have here a new order of facts to be array,ed 
against the data of the thyroidectomies hitherto performed 
by physio-pathologists. 
June 4th, 1896. 



jdbyGoOglc 



THE STIGMATA OF DEGENERATION. 



A Cursory Editorial Critique. 

SCIENTIFIC writers of the Lombroso and Nordau type 
have reached conclusions, we think, too radically 
adverse and illogical against the mental stamina of the 
present generations of men, from their so-called "unerring 
evidences" of the stigmata of degeneration. 

Nordau is perhaps excusable because of his vocation as 
a newspaper man and amateur scientist, being naturally 
enough trained to sensationalism, but the extremely pessi- 
mistic outlook which Lombroso's inadequate and uncritical 
comparisons offer, are scarcely pardonable in a real votary 
of exact science, and the aim of all scientific writers who 
claim public attention to their writings should be absolute 
unimpeachable fidelity to nature and the rules of logical 
deduction in all of their observations and conclusions. 

Not to enumerate all of the many signs of cere bro- spinal 
degeneracy these writers dwell upon, we here only mention, 
diminutive stature, deformities of body, supernumerary and 
deficient members, malformations and asymmetry of the 
cranium and face, malformations and premature decay of the 
teeth, too early baldness and gray hair and, paradoxical as it 
may appear, excessive growth and quantity of the hair, etc., 
etc., though the latter and each and every evidence . above 
given may be and often is a real evidence of individual or 
racial decadence, but they are not invariably nor always so. 

The value of Lombroso's observations and Nordau's 
testimony against the neuro-mental integrity of the human 
family of to-day — the value of their testimony in the direc- 
tion of organic degeneracy, depends upon many considera- 
[62] 



jdbyGoOglc 



The Stigmata of Degeneration. 63 

tions. Conditions of nutrition and strength even of the 
strongest endowed organisms, depend upon the influence of 
environment, as well as of heredity. To be normally resistive 
without undue decay, to have what might be termed pendular 
power of going or falling back only to a certainly defined 
limit, to have due expansibility and contractility, to bend 
like the well strung and tempered bow but not to break under 
severe stress of environment, is to be neurotically normal. 

To break under more than ordinary strain is not to be 
unduly defective. 

But to break under ordinary stress of environment is to 
be neuropathic. 

To let the teeth and hair go prematurely under such 
overpowering influences as an overmastering sorrow or 
bereavement or peculiarly unbearable reverse of fortune or 
unusual stress of toxic disease, coupled with neglected inade- 
quate medication and undermining environment, such as 
would in other natures destroy the integrity of the brain 
and overthrow the reason, is a sign of strength rather than 
of weakness. Nature in such organisms throws off the 
superfluities like a gladiator or a man of war in action and 
holds on to the essentials. They come out of the battle of 
life scathed in these cosmetic appendages, but essentially 
sound in their central organisms. 

Under great stress of study and the persistent goading 
presence of an over-weaning ambition, coupled with a seden- 
tary life, we often see the descendents of great brained and 
bodied ancestors, diminish in stature but maintain the 
ancestral brain power in frames reduced in size only. 

The jewel is there. The casket is good, though smaller 
and will often reappear enlarged to the normal ancestral 
proportions in descendents from whom the pressure of severe 
study and sedentary life in the developmental period of the 
bony frame is withheld. 

This is the normal neurotic resiliency of neurally 
healthy families and where it exists the individual or family 
is not necessarily degenerate and where this regeneracy in 
a race or people is not destroyed the race or people can not 
rationally be said to have become degenerate. 



jdbyGoOglC 



64 An Editorial Critique. 

Pessimistic anthropological writers like Lombroso and 
Nordau do not give adequate logiciil weight to the inherent 
neurotic resiliency of normal organisms. With them all 
apparent are real defects and all are entailed without phys- 
iological attirement in subsequent generations. 

History gives us patent proof of the falacyof some of the 
false anthropological reasoning that has lately set the world 
to lamenting the degeneracy of the race. 

For instance, Byron's hat was too small for the head of 
any of his contemporaries and though he compromised his 
growth during the developmental period and became dwarfed 
in consequence, there is no evidence of degeneracy in Childe 
Harold, but of mental power which should have been allowed 
more years in maturing. His brain and its premature use 
and development shattered his frame as a large boiler and 
engine would a steamboat too small and delicate for its 
power. 

And the animalism of a remote ancestry reappeared in 
some of his moral derelictions after the inhibitions of his 
better nature had been undermined by disease resulting from 
a premature and excessive strain of brain and goad of 
ambition. His poise was disturbed, but cause enough existed 
to change physiological into pathological. 

We guage our great men too severely when, under 
great mental stress, such as entirely destroys ordinary men, 
they reveal some long ancestrally repressed weakness or 
morbid peculiarity. 

Some years ago when 1 was in Washington, circumfer- 
ence hat measurements at a certain Washington hatter's 
were taken by an enterprising reporter scientifically inclined 
like Max Nordau, the newspaper man who wrote "Degener- 
ation" in a fit of pessimistic sensational despondency. These 
measurements included the head covering and showed the cir- 
cular dimensions and peculiar conformation of theheadsof Ben- 
jamin Butler and his colleagues in Congress and the janitor of 
the capital. Senator Dunn, of Indiana, had a circumference hat 
measurement of six and five-eighths just above the ears but 
very symmetrical, Butler's head was "bumptious"asymmet- 
ric, as was the majority, large or small, of the members' 



jdbyGoOglC 



The Stigmata of Degeneration. 65 

heads, while the colored janitor's head showed best of all for 
symmetry and size in these measurements. The story the 
hatter's conformator tells of its record of the inequalities and 
irrej^larities of distinguished heads would astound Lom- 
broso and confound his asymmetry conclusions. Yet there 
is a logical use for asymmetry in determining the question 
of mentality. 

But the duality of the brain as shown in the cerebral 
hemispheres first announced by Wigan and later by Brown- 
Sequard and the vicarious power of the lobes and convolu- 
tions under certain stress of imperative necessity, first 
announced by myself as early as 1872, is something like 
the vicarious and substitutive power of the right and left hand 
when, under certain circumstances the one the individual 
is accustomed to use, is destroyed or disabled. 

As man is ordinarily naturally right handed so he is 
usually left brained, using the left hemisphere almost ex- 
clusively for thinking, the center of active speech being on 
the left side in right handed persons. Yet he can by proper 
and timely training become ambidextrous in the hemispheres 
of his brain as in his limbs. 

The loss of the hair and teeth and the arrest of skeletal 
development under great brain strain is sometimes Nature's 
conservative process as regards the brain's integrity, so that 
neither of these signs are always significant. Were skeletal 
development and stature the test of mental power, where are 
we to place the little corporal who became the greatest 
general of his time, who remodelled the map of Europe, 
placed kingly crowns on the plebian brows of his family and 
defied and made servile even the mighty Hierarchy of Rome? 
He was never equalled as a military strategist and only lost 
at Waterloo when the power. of Great Britain was thrown in the 
balance against him with the aroused antagonism of Europe 
and an accident of dereliction, as a trusted ally failed him 
at a critical moment when his fate was sealed by 
the delay, if not delinquency, of Grouchy. True he 
became a degenerate, had epileptic spells and died of can- 
cer, but so did Thomas Benton of our own State die after 
thirty years in the United States Senate, a giant among 



jdbyGoOglC 



66 An Editorial Critique. 

the mentally great of stature in Washington, and so died 
General Grant after he had saved the Union and a worth- 
less financial confidence man had buncoed him and wounded 
his high and noble spirit beyond mortal endurance, as St. 
Helena broke the spirit of Napoleon, and made him a prey 
to ills of the flesh he had escaped when with his victori- 
ous legions he was master of Europe. 

And just here is one of the potent causes of degeneracy, 
great shocks and strains to the nerve centers of the great, 
weaken resistence to agencies that cause disease. 

Douglas and Greely and Blain died not long after dis- 
appointing defeats, and the strain of premature study took 
several cubits from the otherwise predestined stature of 
Pope and Young, the latter filling an early grave from 
consumption, while Aaron Burr, with a nervous constitution 
built to stand any storm, withstood political failure, disap- 
pointed ambition and merited contumely with the stoicism 
of a Benedict Arnold, as Job endured his calamity with the 
moral heroism of one proud of his integrity and conscious 
of having preserved it. 

In estimating the value of teratological defects it is 
important to consider all casual conditions before making a 
final estimate. Contracted pelves and instrumental delive- 
ries should be estimated as would a club-foot, which may 
be mechanical or developmental as in true talipes, or as in 
the foot of a Chinese upper-class belle, the stigmatum of 
degeneracy being in the latter instance in the mental 
make-up of the parents and the people who countenance 
the torturing deforming procedure developing it. 



jdbyGoOglc 



se:i:ections. 



NEUROTHERAPY. 

ANTIKAMNIA AND THE NEUROSES.— Clinical reports 
verify the value of codeine in combination with antikamnia 
in the treatment of any neuroses of the larynx, coughs, 
bronchial affections, la grippe and its sequelae, as well as 
chronic neuroses. 

DIVISION OF THE CERVICAL SYMPATHETIC IN CASES 
OF EXOPHTHALMIC GOITER.— Jaboulay(ivoKWed(Cj/, 1896, 
No. 22, p 150) has practised division of the cervical sym- 
pathetic nerve in two cases of exophthalmic goiter, with 
resulting diminution in the prominence of the eyes. Both 
nerves must be divided, but the result is not always sym- 
metric, as one of the nerves may be larger than the other, 
and thus capable of more pronounced activity. The opera- 
tion is believed to be justifiable in accordance with the 
intensity of the symptom. 

TABES DORSALIS.— Ostrankow has successfully used 
(iVein. Klin.iVchsck.)oxa\aie of cerium to shorten the gastric 
crisis of tabes dorsalis. In doses varying from 0.15 to 0.50 
gramme {2X to 7H grains) three or four times a day, it 
caused the vomiting to decrease on the second day to six 
to eight attacks, instead of two hundred, as in some cases. 
The nausea and great thirst being thus lessened, a general 
improvement in the mental condition could be noted, and 
small quantities of nourishment could be retained, — an 
important point in these cases. — Univ. Med, Jour. 

UNUSUAL EFFECTS OF THE BROMIDES.— In certain 
epileptics the prodromal signs of an attack and the subse- 
quent manifestations take on an intensity altogether unusual 
[67] 



jdbyGoOglc 



68 Select ions. 

when bromides are being employed in high dose. In cardiac 
epileptics the bromides are Hkewise injurious, cardiac asthenia 
leading to a state of collapse. In children paralytic pheno- 
mena with ptosis, loss of memory, etc., have been noted. 
Homicidal tendencies and melancholia with attempts at sui- 
cide may be observed. — S. Weir Mitchell in Medical Record. 

Insomnia. — Dr. Eccles(5fl«jYflri««)refers to the efficiency 
of the warm bath, if properly carried out, in producing sleep. 
It should be administered in a room with a temperature of 
65" to 70" F. The patient should stand with his head over 
the edge of the tub, and his head and face rapidly 
douched with water at 100". The cooling of the body by 
the air, and the hot sponging of the head, send the blood 
to the head, dilating the vessels of the entire brain. The 
entire body is then immersed, except the head, in a bath at 
98", which is rapidly raised to 105" or 110". In a few 
minutes the patient is taken from the bath, wrapped in 
warm blankets, and, without exertion on his part, taken to 
his room. The blankets absorb the moisture. In his room 
the night clothes are put on, a warm bottle placed at his 
feet, and possibly some warm liquid food administ«red. 
The sedative and refreshing result is often most marked. 

AUTO-lNTOXICATION AND FIG SYRUP.— The energetic 
California Fig Syrup Co. keeps us reminded that they are 
still in the market. They tell us that, "we are indebted to 
the bacteriologists for many things, but they have taught 
us nothing of more practical value than the lesson that a 
large number of our minor complaints and a thousand and 
one of our aches and pains, which make life miserable, 
come from auto-intoxication. The ever present germs in the 
alimentary tract manufacture their toxines and these are 
absorbed much to the distress, if not to the actual danger, 
of the individual." The good old-fashioned theory that you 
must "keep the bowels open" if you wish to enjoy perfect 
health thus finds a scientific explanation in these latter 
days. It is now simply a question of common sense: keep 
the alimentary canal free from the poisons of germ life. 
You cannot do this better than by using California Fig 



jdbyGoOglC 



Selections. 69 

Syrup, pleasant to the palate and prompt to give relief. 
This is not new, but it is true. The Fig Syrup of this 
company is really an elegant senna fig syrup. The senna 
fig syrup people think they have the only thing. We will 
not dispute with them because they certainly have a good 
thing financially and therapeutically. 

THE ANTIRHEUMATIC ACTION OF SALICYLATE OF 
STRONTIUM. — Pure salicylate of strontium occurs in white 
crystalline needles which are slightly soluble in water and 
alcohol. 

It is this salt only which should be administered inter- 
nally. It increases the blood pressure, which is not dimin- 
ished unless the dose is increased far beyond the amount 
required when salicylate of soda is employed. 

It is claimed from clinical observation that in doses of 
five grains, its antiseptic properties are most energetic, and 
it is superior to simitar antiseptics, that ten to fifteen 
grains in gouty and rheumatic subjects give the same 
results as other salicylate preparations, and that it does not 
interfere with the stomach. — Abstracted from Bulletin de 
Therapeutique. 



PSYCHIATRY. 

Mental THERAPEUTICS.— Schofield, The Lancet {Lon- 
don), says the therapeutic influence of the mind on the body 
must be considered of greater practical value in the treat- 
ment of disease than has hitherto been accorded it. Neglect 
of its real value may be ascribed to the fear which physi- 
cians have of injuring their reputation, because mental thera- 
peutics have been heretofore the modus operandi of char- 
latans. 



CLINICAL PSYCHIATRY. 

THE RELATION OF ALCOHOLISM TO INSANITY,— 
Darin (These de la Faculte de Paris, No. 119) states that 
alcoholism is increasing in Italy and Belgium, and especially 



jdbyGoOglC 



70 Selections. 

in France, Corresponding to this increase, the number of 
lunatics has also increased. The gain has been chiefly in 
alcoholic mania and general paralysis. Statistics of the 
different portions of France also show this relationship, for 
where alcoholism is most marked, insanity is most common. 

COMMUNICATED INSANITY.— Dr. Vatlee, Medical Super- 
intendent of the Quebec Lunatic Asylum, in his last report 
comments and records on this subject as follows: Insanity is 
not contagious in the true sense of the word, but at the pre- 
sent day it is generally admitted that it is a disease which 
may communicate itself under certain special conditions. Some 
interesting studies have been published in support of this 
view, amongst others by Las^gue and Falret. "Folie d deux 
ou folie communigu^e" by Lehmann, "Folie induite" by Regis 
and Legraim, "Folie simultanSe," 1 take the liberty of 
referring to this point in this report, because during the past 
year we have received several cases of insanity which really 
seem to have been communicated. The following' is a brief 
summary of these observations: 

On the 19th April we received at the asylum a man 
aged 54 years, suffering from the hallucination that he was 
persecuted and from depression. 

Eight days afterwards his wife, aged 47. was brought 
to us with symptoms of insanity exactly similar to her hus- 
band. Both obstinately refused to eat. The woman had 
fallen sick the first about five months previously; the hus- 
band, an old victim of alcoholism, had attended her very 
devotedly, and after three months of such a life of anguish 
and fatigue, he himself lost his reason. 

On the 20th August three sisters were brought to us 
at the asylum, whose history was as follows: In the month 
of July. 1893, one of them, aged 21 years, had an attack 
of insanity after La Grippe. She was kept at home and at- 
tended by her sisters. Anotiier.aged 35, manifested symptoms 
of insanity in the month of January, 1894. She also remained 
at home, and finally in the month of July of the same year, 
the third, aged 20 years, fell into a state of profound 
melancholic stupor. Not one of them before becoming insane 



jdbyGoOglC 



Selections. 7\ 

was endowed with much inteltigence, but stil! they could 
earn their living lil<e ordinary people. The eldest was a 
teacher. 

On the 5th September we received two sisters, one 42 
and the other 50 years of age. The youngest fell sick in 
the month of June from overwork and want of sleep. She 
had become morose and imagined that people wanted to 
burn her house down and kill her. Her sister, who was 
older and weaker, attended her day and night. This life of 
physical and moral drudgery lasted two months, and then 
the oldest began to manifest the same apprehensions and 
fears. When they reached the asylum both were a prey 
to the keenest terror and most violent despair, and had 
taken no food for several days. 

A CASE OF CEREBRAL ABSCESS SITUATED AT THE 

POSTERIOR Part of the external Capsule.— Charles 

K. Mills, M. D.. and Wm. G. Spiller, M. D., of Philadelphia, 
read a paper before the American Neurological Association on 
this subject as follows: 

The patient had never had earache, but had suffered 
during the summer of 1895 from severe headache. On 
December 20, 1895, he became unconscious and had three 
general convulsions which resembled those of epilepsy. It 
was noticed that he was partially paralyzed on the right 
side and that he could not talk properly. His condition 
later improved very much. On January 29, 1896, he had 
another attack of partial unconsciousness, without convul- 
sions, but with aphasia and decided paralysis. On admission 
to the hospital he was in a condition of stupor; he did 
not speak when addressed, and had almost total right- 
sided paralysis, incontinence of urine and feces, and entire 
loss of pain and touch-sense over the paralyzed side. He 
was found to have right homonymous hemianopsia and 
double papillitis, most marked in the left eye. Death 
occurred February 26, 1896. There was no evidence at 
any time of middle-ear disease. At the autopsy an abscess 
was found in the left hemisphere, just above the level of 
the callosum. Both tympanic membranes were normal. 



jdbyGoOglC 



72 Selections. 

Microscopic examination of the pus from the cerebral 
abscess revealed only the ordinary Staphylococcus pyogenes 
aureus. 

The occurrence of epileptiform convulsions at the time 
of the first attack of unconsciousness, probably due to 
irritation of the motor fibers within the internal capsule, is 
worthy of note as an instance of the difficulty in diagnos- 
ticating cortical lesions. It is not known in what portion 
of the body these convulsions began. The diagnosis was 
made of some morbid process located at the posterior part 
of the internal capsule, involving tht optic radiations and 
causing pressure. The abscess occupied the posterior part 
of the external capsule, a portion of the lenticular nucleus, 
and extended downward into the subthalamic region, but 
to all appearances had not cut the fibers of the optic radia- 
tions nor those of the internal capsule. The loss of func- 
tion in these tracts was probably due to pressure. The 
white matter of the first temporal gyrus was almost entirely 
destroyed, and fibers from the upper anterior part of the 
second temporal were also cut. As the cavity was very 
near the periphery of the first temporal convolution, it 
would not have been difficult for the surgeon to have 
emptied it. Hearing was probably not seriously affected, 
although word-deafness appeared to be present. In view 
of the frequency of cerebral abscess after suppurative pro- 
cesses in the lungs, it may be added that merely spots of 
catarrhal pneumonia were found in both lungs at the 
autopsy. No degeneration was noticed anywhere in the 
motor tract. At all parts a good half-inch of sound tissue 
existed at the posterior part of the internal capsule in the 
area corresponding to the optic radiations and the tract of 
Turck. It has been claimed by Dejerine that fibers arise 
in the temporal lobe (especially in the second and third 
convolutions) pass inward below the putamen, join the 
posterior part of the internal capsule in the subthalamic 
region and then form approximately the external fifth of 
the cerebral peduncle. No fibers from the occipital lobe are 
found in this lateral bundle of the crus. Dejerine has 
found this tract of Turck degenerated in six cases of 



jdbyGoOglc 



Selectiom. 73 

lesions involving ttte middle and inferior part of the tem- 
poral lobe. In the case reported the fibers from the first 
temporal gyrus were almost entirely destroyed as well as 
those from the upper anterior part of the second temporal 
convolutions, and as no degeneration was found within the 
lateral bundle of the peduncle by the method of Marchi 
sixty -eight days after the first attack and twenty -eight 
days after the second, certainly a period sufficiently long 
for this method, the authors consider that the case demon- 
strates the fact that no fibers from the first temporal and 
the upper anterior part of the second temporal gyrus, 
including a portion of the upper middle of this gyrus 
enter the fasciculus of Turck. This does not render impos- 
. sib!e or improbable the origin of such fibres in the lower 
anterior and the whole of the posterior part of the second 
temporal and in the whole of the third temporal gyrus. 
The fibers which enter the first temporal gyrus are proba- 
bly connected with the sense of hearing, and, being sensory, 
probably do not degenerate downward, which accounts for 
the absence of secondary degeneration in the peduncle. 

ANOTHER IDIOT SAVANT.— There died December 3d, 
1896, in the Poorhouseat Palmyra, Missouri, aged forty-three 
years, a Negro, who possessed as remarkable memory for 
words, without other intellectual qualifications as the black 
prodigy, Blind Tom, displayed for musical notes and bars. 
Though he could neither read nor write, and was in all 
other respects an imbecile, he had a remarkable memory 
for spoken words and, it is said, he could recite word for 
word, chapter after chapter of the Bible. Whatever he 
heard read he immediately committed to memory, and never 
forgot it. His remarkable memory has been put to severe 
tests on numerous occasions, and never failed him. He 
recites columns of a newspaper after having them read to 
him, it is said, but once. 



PSYCHO-THERAPY. 

. EARLY TREATMENT OF THE INSANE.— It is well known 
that early treatment of insanity and allied disorders is 



jdbyGoOglC 



74 Selections. 

atteniied by the best results. It is very desirable to separate 
the patient from his family, friends and usual surroundings, 
that his mind may, if possible, be directed in new channels, 
and new acquaintances may cause him to exercise any 
inhibitory powers that he may have. It is of primary im- 
portance to properly regulate the diet, give outdoor exercise 
judiciously, and, in suitable cases, massage, and electricity. 
We have faith in the efficacy of medicinal treatment, intel- 
ligently administered, and we are not in harmony with 
those who discard therapeutics, claiming that they are 
worthless. Medicinal treatment may not only be worthless, 
but harmful, if not intelligently administered, and, to be 
effective, it should be accompanied by every aid known to 
science. Owing to prejudice, or erroneous belief, many 
patients in the early stages of insanity are detained at 
home until the disease has so far advanced that the safety 
of the patient or of his friends demands his removal. 
This is certainly very discouraging to the alienist and 
unfortunate for the patient. — Dr. G. F. Cook, Physician in 
Charge, Oxford Retreat. 

HYOSCIN HYDROBROMIN IN THE TREATMENT OF 
INSANITY.— Dr. H. R. Cosxonsi Nashville Journal of Medicine 
and Surgery) says: Hydrobromin of hyoscin in doses of from 
one-fiftieth to one-twentieth grain, far exceedsall other reme- 
dies which I have ever used in any form of insanity. It must be 
given freely. I have never seen any bad results from its use, 
and in case of acute melancholia with insomnia of a week's 
duration, which I had the pleasure of seeing in consultation 
with Dr. Davis, in which morphine and bromides had no 
effect, I gave one-tenth grain at one dose, and the girl was 
asleep in two minutes and slept eleven hours. She made 
a good recovery. After a large dose the patient will make 
a few gasps, and unless you are acquainted with the 
action of the drug — not from reading but from bedside ob5er- 
vation — you will think he will be dead in a few minutes. 
Let the patient alone and he will be all right; go to 
administering restoratives and you will kill him. — Amer. 
Med. Rgv. 



jdbyGoOglc 



CLINICAL NEUROLOGY. 

APHASIA IN POLYGLOTS.— An article on this subject 
by Dr. Petres in a recent number of the Revue de Medicine 
shows that such patients do not become aphasic in the same 
degree for all the languages. Though at first there is gen- 
eral aphasia, as improvement occurs, the patient comes; to 
understand and speak his most familiar tongue. Less fami- 
liar language; he acquires later. 

BRAIN TOLERANCE TO TRAUMATISM.— Another in- 
stance rivaling the celebrated Pheneas P. Gage tamping- 
iron brain injury, appears in the following case: A young 
man was polishing a brass handle in a lathe making 2,200 
revolutions a minute. By a slip the handle was thrown 
out, and was driven with terrific force into the skull, 
entering the forehead and brain to a depth of three inches. 
He pulled it out, walked two squares, had his head dressed, 
then two squares more to his home. The accident occurred 
at 9:30 in the morning. At 4:30 P.M. he was removed to 
the hospital and at 6 P. M. he was operated upon by fish- 
ing out from a depth of three inches a round piece of bone 
about one and a half inches in diameter. Three small 
splinters of bone were removed from the edges. Fully two 
and a half ounces of brain substance were lost. The wound 
was. washed out with sterilized water, and the cavity 
plugged with sterilized gauze. Six weeks after the accident 
the patient was able to work again. — Dr. E. W. Walker, of 
Cincinnati, in Lancet -Clinic. 

CLASSIFICATION OF EPILEPSY.— Dr. Frederick Peter- 
son, president of the Board of Managers of the Craig 
Colony for Epileptics, has the following to say (Third 
Annual Report) regarding the classification of this disease: 

So little is known of the etiology and pathology of 
epilepsy that it is not possible, in the light of present 
knowledge to make a satisfactory classification of its forms. 
The terms Grand Mai, Petit Mai, Psychic and Jacksonian 
are largely symptomatic designations, and bear little relation 
to causative factors. A classification based strictly on 
etiology is not possible, but none will deny that such a 



jdbyGoOglC 



76 SeUciioiis. 

classification would be more scientific and valuable. In 
the subjoined classification we have omitted the use of the 
term idiopathic, believing that a more specific disposition 
might be made of cases lil<ely to be classed by placing 
them, after closer study, under some less indefinite head- 
ing. The classification here offered is not held to be per- 
fect or even satisfactory, but is used as a working basis 
for future improvement, 

GENITO-NEUROPATHIC— Embracing types tn which various nervous 
diseases. Insanity. feel>le-mindedness. inebriety and degenerative types of 
families of low moral and mental development are found in patient's family 

PoST-ParalVTIC— Embracing types in which the disease follow infan- 
tile or post -developmental paralysis. 

Traumatic— Including cases In which the indenture of the calvarlum 
is manifest, or In which trauma acted more forcibly than a slight determin- 
ant to an existing predisposition. 

HVSTERO- EPILEPSY.— Including alt cases In which hysterical convul- 
sions precede, are concomitant with or follow a true epileptic seizure. In 
some cases of this class hysterical convulsions may alternate with true 
epileptic seizures. 

Hereditary.— Embracing all cases In which the disease can be directly 
traced in the Immediate family history. 

1MBEC1 Lie— Including cases in which imbecility, or lack ol mentat 
development, precedes, is concomitant with or is a sequel to the epilepsy, 

ACQUIRED.— IncludInK all cases in which the disease has (or its etiology 
such deleterious habits, unhygienic surroundings, or toxic states □( rhe 
organism as would cause the disease to appear without a congenital predis- 
position existing. 

SENILE. — Embracing all cases in which old-aged changes are found in 
the arteries, the eye. the gait, posture and defective ideation. This form 
Is comparatively rare. 

STIGMATA OF DEGENERATION.— In the Third Annual 
Report of the Board of Managers of the Craig Colony of 
Epileptics, the medical superintendent. Dr. William P. 
Spratling, makes the following observations relative to this 
subject: 

One hundred and thirty-one of the total number of 
patients admitted presented stigmata of degeneration more 
or less marked, as observed in the following: ear, palate, 
face and cranium. 

Twenty-seven showed deformity of palate only; twenty- 



jdbyGoogle 



SeUctiom. 77 

one of ears and palate; seventeen of palate and face, while 
thirteen and twelve respectively had deformity of face and 
ears alone. Combined types, such as ear and face, palate 
and cranium, were present in the remainder of cases. De- 
formity of palate was present in ninety-three cases; of ears, 
in fifty-five cases; of face, ;in sixty-one cases; of cranium, 
in twenty-six cases. 

The stigmata of degeneration, as noticed in the 131 
cases, are given below in their order of frequency in each 
particular part of the head: 

EAR.— Asymmetry in size, form am) position; prominent or absent eras: 
fusion of helix and anti-helix; triplication of crura. 

Palate. — Asymmetry, narrow high arch (Gothic), domed. Torus and 
flat arch. 

Face. — Asymmetry, lower part contracted, prognathism, abnonnal 
number and position of facial folds, giving rise to semblance of the so-called 
"types of features." 

Cranium. —Asymmetry, Oat occiput, misplaced crown, plagiocephaly 
(obliquely deformed skull) , scaphocephaly, megalocephaly and microcephaly. 
MENTAL Fatigue and exercise.— It has been gen- 
erally accepted' that muscular exercise, gymnastics, was 
beneficial after continued mental effort, and school children 
are often put through a course of gymnastics to dissipate 
their mental fatigue after a morning's study. But Bum and 
others now declare that recent tests have demonstrated that 
fatigue from mental exertion is increased by muscular exer- 
tion, and that nothing will dissipate this fatigue but physi- 
cal and mental rest, viz., sleep, — Jour. Am. Med. Assn. 
from Therap. fVoch. 

WEATHER NEUROSES.— Uwenfeld (Munchmer med. 
tVochenschrifi. No. 5, 1896) refers to various well-known 
• diseases of the nervous system, whose symptoms, or at 
least the intensity of whose symptoms, are greatly influ- 
enced by the state of the weather. This is true troth of 
anatomically demonstrable diseases, and of various neuroses. 
Of the former he mentions the lancinating pains of loco- 
motor ataxia, chronic myelitis, and meningo-myelitis, mul- 
tiple neuritis, and various neuralgias; of the latter, hysteria, 
epilepsia and neurasthenia. He refers further to the also 
well-known influence of the state of the weather on the 



jdbyGoOglC 



78 Selections. 

disposition, desire and ability to work of various nervous 
and other people. In addition to these conditions there are, 
however, various others,— the real "weather neuroses," — 
whose presence is manifest only during certain states of 
weather. At other times the patients usually have no 
complaints. The symptoms of these "weather neuroses" 
are usually pain, generally of a lancinating character, 
paresthesias and muscular weakness. The localization, 
distribution, intensity and duration of these are subject to 
great variation. Complications with other nervous condi- 
tions, especially neurasthenia, are quite common. 

Hereditary influences are of importance in determining 
the condition. The development of the disorder may be 
due to various fever conditions or anomalies of nutrition. 
The majority of cases of pains in the joints and extremi- 
ties in old people, usually incorrectly recognized as chronic 
muscular rheumatism, may more properly be looked upon 
as "weather neuroses." The existing cause of the symp- 
toms is most probably the sudden change in the amount of 
moisture in the atmosphere, the condition of the atmos- 
pheric electricity, and possibly, also, the quantity of ozone 
in the air. The seat of the alfection is in the peripheral 
nervous system, including the nerve roots. The prognosis 
in young individuals and those of middle age without here- 
ditary predisposition is favorable. In persons hereditarily 
predisposed, and in the aged, the prognosis as to cure is 
unfavorable. The treatment should consist of electricity to 
the back and over the nerve course, with attention to the 
general nutrition. In severe attacks in the aged sedative 
drugs are indicated. — University Med. Magazine. ' 

A Case showing the nature of perforating 

NECROSIS OF the SPINAL CORD.— This is the second 
case of perforating necrosis which Dr. Dana puts on record, 
the first having been published in the ALIENIST AND NEU- 
ROLOGIST in 1888. Dr. Dana believes the nature of the 
process to be primarily necrotic, and opposes the view of 
Dr. Van Giesen, who regards it as hemorrhagic in character. 
Case. Man, 40 years old, suffering from progressive 
amyotrophic lateral sclerosis, which began with bulbar 



jdbyGoOglC 



Selections. 



79 



symptoms, then involved arms and legs. After six months, 
fever, acute paraplegia, death. The autopsy showed atrophy 
of the anterior horn cells, lateral sclerosis, acute tubercular 
softening of central cord. There was no sign of haemor- 
rhage in the cord, examined in its fresh state. In the soft- 
ened area tubercle bacilli were found. Examination with 
the microscope showed that the necrotic process was not 
accompanied by any hsemorrhage process. — Chas. L. Dana's 
Clinic reported in the Post Graduate for July, 1896. 

THE SYMPTOMATOLOGY AND PATHOLOGY OF EX- 
OPHTHALMIC GOITRE.— In an article on this subject by 
Dr. William C. Krauss, in which attention is more especially 
given to the "formes frustes," or illy-defmed cases, the 
author thus summarises both the primary or cardinal and 
concomitant symptoms: 

SYMPTOMS OF EXOPHTHALMIC 

Tachycardia. 

VomltinK. 
Dlarrhtea. 
Bulimia. 

Frequent respiration. 
Dyspncea. 
Angina. 

V. Grtefe's sign. 
Mobius' sign. 
V. Stellwag's sign. 
Becker's sign. 
Nervousness. 
Emotional states. 
Neuralgias. 

Epileptiform convulsions. 
Psychoses. 
Vitiligo, urticaria. 
Pigmentation. 
Hyperldrosls. 

Flushings and sensation of heat. 
- VIgoroux's sign. 
Polyuria. 
Albuminuria. 
. Glycosuria. 
Of the Genital Organs. \ "enstrual disturbances. 
I Impotence. 
Anemia. 



Giving way of legs. 



Steondaiy or 
Coneomi- 
tanl Sjmp- 



Of Digestive Tract 



Of Respiratory Tract... 



Of the Eye ... 



Of the Nervous System 



Of the Cutaneous Sys- 



Of the Urinary Tract.-. 



jdbyGoOglc 



80 Selections. 

The four cardinal symptoms are pathognomonic, but of 
these, the author considers tachycardia the most important, 
and may precede the other symptoms by months or years, 
while the exophthalmus is the least often present. 

As to the pathology. Dr. Krauss accepts the theory 
advanced by Kobens and defended by Trousseau, Eulenbiirg 
and Oppenheim, that it is due to some affection of the 
sympathetic nervous system. 

The most important element of treatment is the sys- 
tematic use of the galvanic current, one-half to one and 
one-half milliamperes for from one to three minutes every 
other day. The cathode is applied at the angle of the 
lower jaw, first on one side and then on the other, while 
the anode is applied at the back of the neck. 

The medical agents comprise Strophanthus, in gradually 
increasing doses, cod liver oil, trional for insomnia, bromides 
for quieting temporarily the increased nerve activity, and 
nux vomica and phosphoric acid for dyspeptic phenomena. 
He has no experience with thyroid extract in this disease. 

AN ENORMOUS DOSE WITHOUT DEATH.— The follow- 
ing record of heroic treatment accompanies a note of request 
to publish. We give it place, for comment and warning. 
The amount of Chloral Hydrate and Bromide of Potash, 
to say nothing of the toxic qualities of the extract 
of Cannabis Indica and the extract of Hyoscyamus, giving 
this patient, within two hours, two hundred and forty 
grains each, is enough to put the permanent quietus of death 
upon ninety-nine out of every hundred persons. 

Such a dose as this should not be repeated at shorter 
intervals than twelve hours, even in the most vio- 
lent cases, and seldom in less than twenty-four hours. If 
this was genuine Bromidia with Schiering's chloral, such 
as Battle & Co. put in their compound, it alone should 
have killed the patient. Such prescribing is recklessness 
run riot and would ruin the good reputation of this hypnotic 
compound. 

S. L. Reed, IVl. D., Highland Park, Ky., writes: Was 
called suddenly to see Mrs. McG. Patient had been under 
tre;itment of Dr. R., who had been called, but failed to 



jdbyGoOglC 



Selections. 81 

Found patient suffering with Acute Mania, very 
violent and destructive. On questioning family found patient 
liad delivered herself four days previous of a three months' 
foetus. Since that time patient had been receiving enor- 
mous doses of morphine with no apparent result. As patient 
was beyond control, improvised a straight jacket of her 
husband's sweater and bicycle belt. Ordered half ounce 
Bromidia (Battle & Co.) every half hour until quiet. In 
two hours patient was sleeping. Patient continued to 
receive Bromidia whenever indicated, along with other 
treatment, and in a few weeks was apparently well although 
she is still under observation. This will show the supe- 
riority of Bromidia over morphine, especially in cases with 
head symptoms. 

Had this patient remained somnolent long enough to 
have taken another dose the undertaker would have fmished 
the record. Half hour intervals foi dram doses of chloral 
are dangerous. 



NEURO-DIAGNOSIS. 

ROENTGEN RAY LOCATES BULLETS THROUGH THE 
SKULL.— The Deutche med. tVock. August 13th, 1896, brings 
us actual protographs of the heads ot a couple of Eulen-% 
burg's patients, in which the Roentgen ray discloses and 
locates a bullet inside the skull. The photograph was taken 
with the head of the patient resting on the plate holder 
with the Crookes' tube about 24 c. above. 



NEURO-PHYSIOLOGY. 

INFLUENCE OF THE VAGUS ON THE SECRETION OF 
URtNE. — Walravens (Archives Haliennes de Biologie, xxv, 22) 
confirms the observation of Masius and others that faradi- 
zation of the peripheral end of the vagus in the neck arrests 
the flow of urine. This effect is not, however, obtained if 
the animal is first atropinized. Hence Walravens considers 
that the arrest is due simply to the action of the vagus 
upon the heart and circulation, and not to any vasomotor 
fibres going from it to the kidney; if these existed they 



jdbyGoOglC 



82 Selections, 

would not be paralyzed by the small dose of atropine, which 
obviates the action of the vagus iipon the heart. The 
author holds that all the observed facts may be explained 
by the variations in the aortic pressure. Stimulation of the 
central end of the vagus is found usually to increase the 
flow of urine, though there is often no effect. This, again, 
is probably due to rise of blood pressure, and is related to 
the polyuria following puncture of the fourth ventricle. 
Walravens thus concludes that the vagus exercises no 
secretory influence on the kidneys. — Brit. Med. Jour. 



jdbyGoOglc 



EDITORIAL. 

[All Unsigned Editorials are written by the Editor.] 

I^No commission allowed agents or dealers on renewal subscrlp- 



Our Mutual Interests. — Under this caption the 
Medical iVorld for November, 1896, publisiies a communi- 
cation from a subscriber, with editorial comment, on the 
exorbitant charges of express companies. Facts and figures 
are in evidence of the excessively high rates charged 
individuals, whereas manufacturers and dealers are gxwen 
comparatively low rates, thus a great saving is had by 
having charges prepaid by firms sending packages to pur- 
chasers. 

The remedy advised is to enlarge the United States 
Mail service to include the express business, as in England, 
where a twelve-pound package is carried to any part of 
the kingdom for eleven cents — a very low rate in compari- 
son with existing express charges in this country. 

The Relationship of Pedology to Nenrology. — 

Our attention has been called to a series of articles on the 
treatment of mentally backward and defective children, as 
well as a consideration of scientific Pedology, which will 
appear during the coming year in the pages of Pediatrics, 
beginning with October, 1896. In his editorial in the issue 
of Oct. 15th, Dr. Witmer (the professor of Experimental 
Psychology in the University of Pennsylvania) indicates 
with striking clearness the close relationship of pedology 
and neurology. He shows how the one cannot be properly 
applied without a grasp of the other, or without the assist- 
ance and co-operation from the neurologist, offering in turn 
to contribute something to a solution of puzzling questions 
relative to the seat and workings of the higher mental 
faculties and the processes that subserve them. 

The publication of these articles indicates a distinct 
advance in the theoretical and practical handling of a class 
[83] 



jdbyGoOglC 



84 Editorial. 

of cases which interest the neurologist, the psychologist 
and the pedagogue. Pediatrics is in line with advancing 
neuriatry and psychiatry. 

The Barnes Medical College and the Cleveland 
Medical Journal. — The Cleveland Medical Journal is 
away off in its reference to the Barnes Medical College of 
St. Louis. It has been imposed upon. The Barnes Medical 
College has employed no legal talent to fight any state 
board, and does not object to any standard as too high, 
agreed upon by the Medical profession. Malicious minds 
have made such statements for some inscrutable purpose. 
The Barnes Medical College students pass all state boards. 

Dr. Prank Parsons Norbary, Managing Editor of 
the Medical Fortnightly, St. Louis, took charge of the 
medical supervision of Oak Lawn Retreat (McFarland's 
Institution), November 15th 1896. 

A good choice for this institution. 

Modern Greek as the Language of Science.— 
An Athenian newspaper, the Kaipoi, prints the following 
remarks introductory to a translation of Dr. Achilles Rose's 
lecture given at the Academy of Medicine a few weeks 
ago: 

Efforts are b«)ne made In America to do away with the Erasinian pro- 
nunelation. The 'At- ovt'! (tne Creek journal of New York) and the 
patriotic Professor Leotsakos started the fight in the American periodicals, 
but the true apostle, the ardent and zealous defender of our true and his- 
torical pronunciation and language In the New World, Is the distin|:ulshed 
American physician and Hellenist. Dr. Achilles Rose. This learned and 
Indefatigable Phllhellene, who has promoted a better knowledge of living 
Greek by his writings and lectures, who by his areuments, which could not 
be contradicted, has upheld the true Greek pronunciation, has at the same 
time undertaken the herculean work of advocating Greek as the interna- 
tional language of science. We deem It our duty to make known to the 
Greek public the profound and scholarly lecture published in the Ntw York 
Medical Jountal. which lecture gives a study of the historical evolution of 
the Greek language and the various phases through which it has passed. 
This lecture was delivered recently In New York before a numerous and 
select gathering, was loudly applauded, and alter having appeared In print 
was highly appreciated by American scholars.— N. Y. Med. Jour. 

Medico-Psychological Association of Great 
Britain and Ireland. — The last general meeting was 
held at the rooms of the Association, 11 Chandos Street, 
Cavendish Square, on Thursday, November 19th, under the 
Presidency of Dr. Julius Mlckle. 



jdbyGoOglc 



Editorial. 85 

The following papers were presented: Dr. Mercier, 
"To examine the alleged exceptions to the Rule of Secrecy, 
and to movtf a resolution;" Dr. C. H. Bond, "Further 
points in the relation of Diabetes to Insanity." 

The President, Dr. Mickle, had suggested the following 
subjects for the Essay for the Bronze Medal and Prize of 
Ten Guineas, which is open to all Assistant Medical Officers 
of Asylums, though candidates were at liberty to present 
an essay on any other subject if they preferred to do so; 
(I) "Heredity in relation to Insanity;" (2) "The f^fe of 
Syphilis in the production of Mental Disease;" (3) "A 
contribution to the Study of Microscopical Change of the 
Nervous System in Mental Disease." 

The members dined together after the meeting at the 
Cafe Royal, Regent Street, at 6:30 p. m, 

Dr. P. O. Hooper Re-elected.— l\\e Board of 
Charitable Institutions of Arkansas has elected Dr. P. O. 
Hooper to tile position of superintendent of the Insane 
Asylum of that State at Little Rock, made vacant by the 
resignation of Dr. J. J. Robertson. Dr. Hooper resigned 
this position four years ago, after holding it for eight years, 
and was succeeded by Dr. Robertson. 

This is a good appointment and a proper recognition 
of clinical familiarity with the insane in the selection of the 
Medical head of a hospital for the insHne. In selecting such 
a man the Board has recognized its obligation to the insane 
of the State, who are entitled to experienced medical min- 
istrations, and to the people of the State whose taxes pay 
for cures and the best care of these unfortunates. 

Dr. Hooper was born in Arkansas in 1833, and received 
his literary education in Little Rock and Nashville, Tenn. 
He graduated trom the Jefferson Medical College, at Phila- 
delphia, in 1856, practicing his profession in Little Kock 
without interruption, save the civil war, serving faithfully 
as president of a board of examining surgeons in the Con- 
federate army until its close, attaining a reputation not 
only in his own but adjoining states. He may be said to 
have been the father of the Arkansas insane asylum, being 
president of its first board of trustees until 1883, when he 
accepted the superintendency in order to see that all his plans 
were carried out relative to the building, grounds and 
methods of treating inmates. He served in this capacity 
until three years ago, when he resigned, leaving it an 
institution, a model of its kind, and with but few rivals in 
any State in the Union. His resignation was received with 
universal regret. Dr. Hooper is also one of the physicians 



jdbyGoOglC 



86 Editorial. 

who helped to organize the medical department of the 
Arkansas Industrial University and was dean of the faculty 
for some time and has continued to give lectures in the 
college on mental and nervous diseases. He was first 
Vice-President and acting President ot the American Medical 
Association that met at St. Paul, Minn., in 1883, in lieu of 
the venerable Dr. Atlee, of Pa., who could not attend, and is' 
a member of the State Medical and various national societies. 
Arkansas has in this instance secured the right man for the 
right place. 

The Second Pan-American Medical Congress 
held last November in the City of Mexico, was a gratifying 
scientific and numerical success. We congratulate Secretary 
General Dr. Liceaga and his able aids, and the Mexico 
profession in general on the interest taken in the work, 
and upon the fraternal and personal hospitality extended to 
the profession of the United States. It was a matter of 
great regret to us personally that on account of illness 
we were unable to attend and take the part we had hoped 
and been solicited to take in this important medical 
convocation. 

The True Criteria of Insanity . — 1. The cause 
and condition within the organism of all insanity is dis- 
ease. 

a. The disease of insanity always, either primarily or 
secondarily, directly or remotely, organically or functionally, 
involves the brain. 

b. Primarily, as in paresis, the acute mania of trau- 
matism, etc. Secondarily, as in postepileptic, post choreic, 
post febrile, post hemiplegic, insanity, etc. The latter being 
sometimes primary and precedent. 

Directly when the morbid cause developes it at once, 
as in toxic and traumatic forms. Remotely where ancestral 
influences have developed a neuropathic diathesis rather 
than a psychopathic, and where conjointly, disease elsewhere 
in the organism has by persisting pain, or other form of 
transmitted or reflected irritation, developed functional men- 
tal aberration or when the insane diathesis is so marked 
that slight exciting cause, insufficient in others, precipitates 
the psycho -cerebral disease. This is also functional insanity. 

Organically, as in the forms which develop concomi- 
tantly with cerebral changes in the neurons or Meninges of 
the cerebrum or other destructive changes of the brain sub- 
stance, ventricles, circulation or coverings, including also 
the cerebellum. 



jdbyGoOglC 



Editorial. 87 

2. The cause within the organism, being disease, 
insanity is developed by many or most of the developing 
causes of disease — physical or psychical — if the cause be 
potent enough to greatly involve the brain. 

3. As a disease, insanity is subject to the law of dis- 
ease in general, j. e., change from the physiological to the 
pathological in the functioning of the organ involved — change 
in its normal manifestations, (, e., change in its functional 
character, as well as its organic conditions. 

4. Non-congenital insanity is there/ore a cerebro-psy- 
chic disease primarily or secondarily involving the brain to 
such an extent as to markedly change the normal mental 
character of the individual. 

To determine the existence of insanity in an individual, 
therefore, disease is to be sought tor, and the standard of 
symptomatic comparison is the individual's former and nor- 
mal psychical character, and the abnormal psycho- sympto- 
matic display is to be compared with the previous normal, 
the psycho -pathologic compared with the psycho-physiologic 
character of the individual. 

Where so-called teratological states appear {which are 
the product of ancestral disease and also really morbid as 
well as abnormal) the standard of comparison should be the 
psychically healthy types of the family, for insanity always 
d splays a change of mental character different from normal 
psychic display and is always the manifestation of disease 
involving the brain and may be termed cerebro- mental 
disease. 

Nenriatry and Psychiatry. — The Archives de 
Neurologie for September, 1896, contains a report from the 
proceedings of the late Congress of Alienists and Neurologists 
at Nancy, of the opening address of Prof. Pitres, in which' 
he makes a powerful plea for the practical union of psy- 
chiatry and neurology, or what we offer as a better term, 
Neuriatry, a term which has just philological warrant for 
a place in the nomenclature of neurology. 

Our worthy contemporary, the Boston Medical and Sur- 
gical Journal, under caption of the Union of Neurology and 
Psychiatry, antedates us in the reproduction of a portion of 
M. Pitres' address and in approbation of the proposition to 
blend the two specialties in one department of research and 
practice. 

We fully concur in the proposition, and in defence 
thereof take the pleasure in laying before our readers a por- 
tion of Ni. Pitres' address, and our Boston contemporary's 
concluding reasoning thereon. 



jdbyGoOglc 



88 Editorfal. 

"The moral of this," says Pitres, "is that we should 
not shut ourselves up in too narrow or too exclusive special- 
ization, and that we should do all we can to enlarge our 
horizon. A neurologist would have insufficient culture were 
he not familiar with the progress of psychiatry, and an 
alienist would be deprived of precious elements of informa- 
tion if he did not follow with an attentive and curious eye 
the researches made in the domain of neurology." 

"For these reasons," he continues, "it is indispensa- 
ble to complete, each by the other, the researches of the 
neurologists by those of the alienists. They are absolutely 
united. They march side by side. They have the same 
objects, the same tendencies, the same methods, the same 
ends. They ought not to be separated. 

Our contemporary adds, "Great discoveries in one field 
have never failed to extend their influence into the other. 
The sciences are apt to progress much more by their influ- 
ence upon other sciences than by discoveries in their own 
domain. The principles of degenerative heredity were 
studied by Morel in mental disease and applied by him 
solely to the etiology of psychopathies and neuroses, but 
they have been extended to all nervous diseases, and are 
applicable to many morbid states. On the other hand, the 
laboratory work in bacteriology was at first thought appli- 
cable only to general febrile and epidemic diseases. Later, 
rabies, tetanus and other affections were found to be due 
to infectious causes, and, finally, the influence of infectioh 
in the etiology of nervous and mental diseases has been 
found to be widespread, as the discussion at the Washing* 
ton Congress in 1894 showed." 

"It would, indeed, be conducive to the highest develop- 
ment, both to psychiatry and neurology," says the journal 
further, "if the teachings of this address could bear fruit, 
not only in France, but throughout the world." And so say 
we with all the emphasis of a long combined clinical experi- 
ence in both departments. 

To the Members of the Medical Profession. — 

Dr. Geo. M. Gould makes the following appeal: 

I would be pleased to have an expression from you, either personalty or 
through some medical Journal, as to ttie lay-pubtlshlng tinns of medical 
journals and the profession. The request Is suggested by the fact that 
Messrs. Wm. Wood It Co., of New York, refused to permit the editors of 
"The American Year-Book of Medicine and Surgery" to use In our abstracts 
of Medical Progress, articles and Illustrations first printed In the "Medical 
Record" and the "American Journal of Obstetrics." 119 S. 17tl) Street, 
Phlladelphfa. Pa,, Dec. 1896. 



,db,Goo8lc^^ 



Editorial. 89 

To which we answer as follows: Unless an article in 
a medical Journal, or the journal publishing the same is 
copyrighted no other publication can be debarred from 
usina it. Besides, the journal or publishing house refusing 
the ordinary liberty of abstracts is lacking in fraternal 
courtesy and journalistic comity, and risks being boycotted 
by the profession. Even though copyrighted such a course 
is unwise, unjust and antagnostic to the charitable and 
fraternal spirit of the code of ethics. 

Dr. P. M. Wise, formerly of Clarence, Erie County, 

N. Y., has been appointed state commissioner in lunacy 
vice Dr. Carlos F. McDonald resigned. 

Dr. Wise was educated in the common schools, at 
Clarence Academy and at the Parker Classical Institute, 
graduated in medicine from the Buffalo University Medical 
College in 1872, and entered the St. Louis City Hospital 
as interne, afterwards resident physician of the small-pox 
hospital. In 1873, he was appointed as assistant physician 
at the Willard Asylum for the Insane, and so remained 
until 1884, when, upon the resignation of Dr. Chapin, he 
was elected to fill the vacancy as medical superintendent. 
He occupied this position for six years, afterwards filling a 
similar position at the St, Lawrence Hospital until the 
present time. 

He was also professor of mental diseases in the Uni- 
versity of Vermont. The appointment is a good one for 
the state of New York and her insane. 

Dr. John B. Hamilton, of Chicago, editor of the 
Journal of the American Medical Association, has resigned 
his commission as surgeon in the U. S. Marine Hospital 
Service. Dr. Hamilton will now have more time to devote 
to his growing surgical practice and engrossing editorial 
work. 

Mimic Locomotor Ataxias. — The experienced Neu- 
rologist meets many cases in the course of an extended 
practice which, once diagnosticated as probable posterior spinal 
sclerosis, ultimately prove to have been the result of a 
previous neuritis, alcoholic, rheumatic, Grippal or syphilitic, 
the fulgurant pains never having existed, the Argyll-Robert- 
son pupil never having appeared, the cincture feeling never 
having been a permanent symptom nor the Romberg sign, 
nor the true ataxic gait, though the walk is clumsy and 
shuffling, or in a manner ataxic. The only persistent and 
invariable sign in these cases being the absent patellar 
tendon reflex. 



jdbyGoOglC 



90 Editorial. 

On this subject a young and aspiring neurologist, writes 
us as follows: "I wish to contribute to your columns a 
publication on painless locomotor ataxia. I have observed 
two patients who have felt all symptoms of locomotor 
ataxia but no pains whatever, either in legs, abdomen or 
elsewhere. As the text-books at my command point to 
the pains as one of the symptoms sine qua noti for a 
diagnosis of locomotor ataxia, 1 should think this is some- 
thing worth mentioning. What I would like to ask you is, 
does the profession generally know that there are cases 
of locomotor ataxia without pain, and is this impossible, 
and consequently was the diagnosis wrong, and, if so, what 
else could it be that would so strongly resemble locomotor 
ataxia, especially the incoordination?" 

This question we have partly answered in the begin- 
ning. We have seen an instance of plumbism when the 
knee-jerk could not be elicited and the same condition 
after and during the status epilepticus. 

The hond Bill (H, R. 4566) ought to be defeated. 
Though its name is Loud with a big L, it is a covert and 
silent attack on the people's rights as readers. 

While purporting to relieve the postal department, it is 
really an enactment intended to embarrass the publication 
business, handicap the dissemination of cheap literature 
among the people and to promote the interests of the 
express companies. Look at this section for instance. 

SEC. 5. That publishers and others, whose publications shall i>e 
admitted as mail matter ol the second ciass under the provisions of this 
Act, shall be required, before depositing; such mail matter in the posl-oflice, 
to separate the same into United States mail sacks or bundles by Slates, 
Cities, towns and counties, as the Postmaster-General may direct. 

It strikes a^ all American asylum, hospital and other 
eleemosynary annual reports. 

The Southern Surgical and Gynecological 
Association held its ninth annual meeting at the Nichol- 
son House, Nashville, Tennessee, on November 10, 11 and 
12, 1896. An interesting programme was presented. Dr. 
E. S. Lewis, of New Orleans presided, and delivered an 
entertaining and instructive address. 

A New Materia Medica by Dr. Frank P. 
Foster. — We have received from the publishers, D. Apple- 
ton & Co., the first volume on this subject, which 
will be reviewed when the second volume comes to 
hand. If the new Materia Medica should prove as meritor- 



jdbyGoOglC 



Editorial. 91 

ious as the dicti inary edited by the distinguished author, 
of which we can entertain no doubt, it will be worthy a 
high place in the literature of medicine. 

Dr. John H. Callender, a distinguished Alienist 
and personal friend of the editor of this journal, died at his 
home in Nasiiville. Tenn., Aug. 31, 1896. Ur. Callender 
came from a distinguished ancestry, his grandfather, James 
T. Callender was a political writer of great prominence 
during the administrations of Washington, Adams and 
Jefferson. Dr. Callender was summoned for the government 
as an expert witness on the question of the insanity of 
Guiteau, but believing with the editor of this journal that 
Guiteau was insane, dechned to testify against him. 

Dr. Callender was for many years the medical super- 
intendent of the Tennessee Hospital for the Insane at 
Nashville, and was superintendent of the "Morningside 
Retreat" at the time of his death, had been president of the 
American Medico- Psychological Association, and filled the 
chair of psychological medicine in the Nashville Medical 
College. He was also chairman of the section on Physiology 
at the Centennial Medical Cong ess of 1876. He was a 
scientific and impressive teacher of psychiatry, an accom- 
plished physician, an eloquent speaker and a courtly gentle- 
man. Sincere and deep in his attachments, he was much 
esteemed by all who enjoyed his friendship. 

A Tough Citizen of Columbia, Missouri, either 
inherently immune to toxicity m general, or brought to that 
condition by self anti-toxine treatment, as he asserts, is 
giving test seances to the profession of Los Angeles, Cali- 
fornia, and at last account had injected hypodermically a 
quantity of sputum, containing twenty-five active baccilli 
taken from a far advanced consumptive. Whether the pro- 
cedure shall prove to be a fake, folly or fact and "Poweliza- 
tion" is to become a scientific, therapeutic procedure remains 
to be proven. Powell is the name of the audacious Colum- 
bia doctor now undergoing the toxine tests. 

Hereditary Neuropathy and Crime.— Professor 
Belman, of the Uuiversity of Bonn; gives the history of a 
notorious drunkard who was born in 1740 and died in 1800 
and her heirs to the number of 834. of whom 709 have 
been traced from their youth. Of these 7 were convicted 
of murder, 76 of other crimes, 142 were professional beg- 
gars, 64 lived on charity, and 181 women of the family led 
disreputable lives. The family cost the German govern- 
ment for maintenance and costs in the courts, almshouses 



jdbyGoOglC 



92 Editorial. 

and prisons no less a sum than ;S1, 250,000; in other words, 
just a fraction under SI, 500 eacli. Tliis transcends the fatal 
immoral heredity of the Jul<es family of Massachusetts and 
the tables of vicious decadences of Irtorel and others. 

Among the Neurological Treatises creditable to 
American medicine there has been issued from the American 
press during the past year, "Nervous Diseases by American 
Authors," edited by Dr. F. X. Dercum; a treatise on "Nerv- 
ous and Mental Diseases," by Landon Carter Gray, pub- 
lished by Lea, Brothers & Co., and "Architecture of the 
Brain," by D. Wm. Fuller, of Grand Rapids, Michigan. 

The Management of the Journal of Nervous 
and Mental Disease, announces the following arrange- 
ment of the staff for 1897: Editors, Dr. Charles L. Dana, 
Dr. F, X. Dercum, Dr. Philip Coombs Knapp, Dr. M. Allen 
Starr, Dr. Charles K. Mills, Dr. James J. Putnam, Dr. B. 
Sachs; Associate Editors, Dr. Philip Meirowitz, Dr. Wm. 
G. Spiller; Managing Editor, Dr. Charles Henry Brown. 

Over the Hookah.— The Pencription thus discourses 
of Dr. Lydston's new literary venture: 

Every little while we are given a book lliat pretends to be a humorous 
work written by a funny dOi:ti>r. which contains generally a lot of nasty 
stories which are supposed to contain a whole lot of fun. The book before 
us. however, is brlm-(ull o( the hiKher order oi wli, and we feel quite 
contidant that It will came into the dKtor's library a welcome guest, for not 
he alone but all his family may enjoy It. 

True, every word. 

'Change of Name.— The editors of Mathews' Medical 
Quarterly announce that with tlie January issue of that 
publication its name will be changed to Mathews' Quarterly 
Journal of Rectal and Gastro- Intestinal Diseases. This is a 
change which has been deemed necessary for some time, 
as it is essential that the title of a medical journal should 
convey to the reader an idea of its contents, and this has 
not been the case with its name from the beginning. 

There will be no change in the policy of the journal 
in the least. As it will continue to be the only English 
publication devoted to diseases and surgery of the rectum 
and gastro-intestinal tract, the articles which will appear 
in it will be limited to these subjects. The journal will 
continue to be edited by Drs. J. M. Mathews and Henry 
E. Tuley, and published in Louisville, Ky. 

The Vnrelibility of Borax in the treatment of 



jdbyGoOglC 



Editorial. 93 

epilepsy with an account of purpura borique as an incident 
of tliis form of medication for epiiepsy is the subject of an 
article by M. Cli. F^re, Medecin de Bic&tre, in Nouvelle 
Iconographie de la Salpetrieri. 

This medicament is of no real service in epilepsy, 
shortly after it was first announced we gave it a sufficient 
trial to satisfy us of its unreliability. It is also objection- 
able because of its not being acceptable to the stomach or 
intestinal tract of many patients, and because of its dis- 
agreeable taste, bulk and an insolubility in water. The 
borax fad has had its day in neurotherapy. 

The Functions of the Nenron. — The most interest- 
ing subject presented at the June meeting of the American 
Neurological Association was that presented in president 
Ur. F, X. Dercum's address. On the above subject Dr. D. 
said: 

The question had arisen in his mind as to whether the 
neuron was not an absolutely fixed morphological element, 
and whether it diJ not possess a certain, though perhaps, 
limited power of movement. He found that this thought 
had occurred independently to three other observers, one 
in Germany. :tnd two in France, Hamon Cajal, however, 
opposes the theory of the mobility of the neuron, and 
maintains that the neuroglia cells possess a great deal of 
mobility. He points out, for instance, that the neuroglia 
ceils of the cortex are at times stellate, and at others much 
elongated. Their processes have numerous short arborescent 
and plumed collaterals. Two phases can be observed in 
them, first, a state of contraction, in which the cell-body 
becomes augmented while the process become shortened 
and the secondary branches disappear, and secondly, a 
state of relaxation, during which the processes of the 
neuroglia cells are again elongated. He further maintains that 
the processes of the neuroglia cells, in reality, represent 
an insulating or non-conducting material, and that during 
the period of relaxation they penetrate between the arbori- 
, zations of the nerve-cells and their protoplasmic processes, 
and render difficult or impossible the passage of nerve - 
currents. On the other hand, when the processes of 
neuroglia cells are retracted, the various nerve-cell pro- 
cesses which they formerly separated from each other are 
now permitted to come into contact. It, seems, therefore, 
thit Ramon Cajal admits the very thing against which 
he contends. 

Take the simple example of an hysterical paralysis 



jdbyGoOglC 



94 Editorial. 

and see how easily it may be exp>ained. The neurons 
of a certain area of tlie cortex, for instance, retract the 
terminal branches of the neuraxon to sucli an extent 
that the latter are no longer in contact, or sufficiently 
near to the neurons in the spinal cord which supply the 
muscles of the paralyzed parts. When power is suddenly 
re-established in hysterically palsied limbs, it simply means 
that the terminal branches of the cortical neuraxon. pre- 
viously contracted, are again extended so as to re-estab- 
lish Hie proper relations with the spinal neurons. It would 
be interesting to follow out the ideas here brought for- 
ward in their application to the various phenomena pre- 
sented by hysteria. 

Turning to hypnotism, a ready explanation is afforded 
for the phenomena presented, and leaving this jield entirely, 
we can see what an enormous value this interpretation of 
cortical action is for normal mental phenomena, taking 
for example the familiar instance of sleep. 

According to Holy Writ. — For one to enter his 
tenth decade with all the faculities intact, with mental 
vigor unabated, and with body bowed by no burden other 
than the weight of years, is extraordinary. But it is 
well nigh marvelous that one should more than fill this 
measure of time, who for nearly seventy years had endured 
the self-ignoring life of a country doctor of the old school. 
Some idea of the superior quality of such a man may be 
gained by estimating the capacity of an intellect which 
could grasp and assimilate all those stupendous changes in 
medical science and practice which have take place within 
the nineteenth century; and contemplating knowledge which, 
ever progressing, not seldom leading, was to the end of 
life fully abrest the times. 

This man was Doctor Hiram Corson, and this is the 
tribute The Medical and Surgical Reporter pays him. 

Teach Medical History. — Under this caption the 
Philadelphia Polyclinic urges the teaching of medical history 
in our medical colleges. 

"The history of medicine, its developments, its errors, 
its trials, its triumphs, should be systematically taught by 
competent instructors at all our colleges. The chair of the 
History of Wedicine should be one of the most important, 
and by the respect paid to it, the value of its teachings 
should be emphasized." 

The relationship of the recent discoveries of bacterio- 
U>jiy of toxines, ptomains, etc., and the revival of mesmer- 



jdbyGoOglC 



Editorial. 95 

ism under the guise of hypnotism, and the relation of 
thyroid and other animal extracts to old hypotheses is 
referred to by the Polyclinic. 

We fully concur with our contemporary as to the value 
of such study to student and physician. The Barnes 
Medical College of St. Louis had such a chair most worthily 
filled by Prolessor J, S, B. Alleyne. M. D., vacated last year 
by his sudden death. This post is to be filled by retiring 
veterans in medicine instead of the usual chairs emeritus. 

Des Attitudes Anormales, Spontanees ou Pro- 
voquces, Dans le Tabes Dorsal Sans Arthropathies 

by Le Dr. Frenkel, de Heid^n (Suisse), and Maurice Faure, 
Interne de la Clinique des Maladies du Systeme Nerveaux, is 
an interesting and valuable contribution to the new symp- 
tomatology of tabes dorsalis. 

The spontaneous hyper-extension of the knee, the 
extreme mobility of the vertebral articulations, the passive 
hyper- extension of the fingers, the extreme laxity of the 
external ligaments of the titiio-tarsal joint and the extreme 
laxity of the hip joint articulation, are well illustrated and 
described by the distinguished gentlemen, whose names appear 
above, in Le NouvelU Iconographie de la Salpetri^re for 
July and August, 1896. 

These new features in the symptomatology of tabes 
dorsalis are quite interesting. Dr. J. J. Putnam, of Boston, 
having already called attention to the laxity of the hip- 
joint articulation in this affection. 

The Physicians of Santa -Clara County, CaL, 

numbering 124, have eptered into a compact to not enter 
into any contract or agreement, or renew any existing 
contract or agreement, either written, verbal or implied, 
to render medical or surgical services to any lodge, society, 
association or organization. Investigation shows that medi- 
al compensation for lodge work averages in that county 
bout fifteen cents on the dollar. 

This is a wise move in the direction of professional 
protection. Respectable physicians feel a sense of degrada- 
tion in giving their services for fifteen cents on the dollar, 
and the ever-increasing spread of these charitable institu- 
tions is absolutely destructive to the business of other 
physicians. 

Notice to SabscriiKrs and News Agents. — Regu- 
lar renewals of old subscribers to the ALIENIST AND 
NEUROLOGIST are not discounted to agents. A recent 
protest of a New York agent for foreign subscriptions corn- 



ed byCoOglc 



pells us to call renewed attention to this fact. We discount 
to agents only for new subscriptions. 

The Change in the Presidency of the State 
Commission in Lunacy.— lUt: retirement of Dr. Carlos 
F. MacDonald on September 30th from the presidency o' 
the State Commission in Lunacy, an office which he ha 
held since the creation of the commission in 1889, mark 
an important era in one of the most important and exten 
sive departments of the State government. Dr. MacDonald 
was impelled to take tliis step by a due ctmsideration to 
his private interests which have been seriously impaired by 
his attention to public duties. He has succeeded the late 
Dr. Choate as physician in charge of a high class sani- 
tarium for the treatment of select cases of mental disease 
at Pleasantville, Westchestej county, and will personally 
conduct it, retaining an office in New York irity for consul- 
tations. In his letter of resignation to the Governor, Dr. 
MacDonald says: 

"In taking this step I deem it due to myself to make 
the following brief statement in explanation thereof: The 
complete fulfillment of the object — State care for the depend- 
ent insane — which induced me to relinquish a less respon- 
sible and more lucrative public office to accept, at the 
invitation of Governor Hill, the presidency of the State 
Commission in Lunacy on the creation of that body in 1889, 
has relieved me from the moral obligation which 1 then 
assumed and which ■ was renewed when, in 1895, you 
reappointed me for another term of six years. In other 
words, the accomplishment within'the present year of this 
great reform in behalf of the dependent insane, for the 
consummation of which all true friends of that unfortunate 
class are deeply indebted to you, has left me free to avail 
myself of the opportunity which has come to me to retire 
from the cares and responsibilities of public service to which 
twenty-seven years of my professional life have been given 
in connection with the care of the insane, to the more 
peaceful and more adequately compensated walks of private 
professional practice. 

"I need scarcely say that this step which terminates 
the pleasant official relations which I have been permitted 
to have with yourself, as well as with my associate com- 
missioners and the officers and employes generally of the 
department for the insane, is not taken without a feeling 
of sincere regret on my part. 

"In conclusion, I would take occasion to express my 



jdbyGoOglC 



Editorial. 97 

deep sense of personal obligation to you, as well as to your 
predecessors. Governors Hill and Flower, for the contidence, 
encouragement and support which you and they have at all 
times extended to me in the discharge of the arduous and 
oftentime trying duties of my office, and especially for sustain- 
ing the Commission in its endeavor to maintain the depart- 
ment of the State government over which it presides on a 
non-partisan basis." 

Of the value and extent of the service rendered by 
Dr. MacDonald to the people of this State in the seven 
years of his membership of the Commission, few persons 
not directly and intimately connected with the general 
administration of lunacy affairs can have any adequate 
idea. To him more than to any other one person may be 
assigned the chief meed of praise for the final establishment 
of the policy of State care on a stable and durable basis, 
as an effective, economical and practical measure of dealing 
with the largest and most costly of the State's charities. 
In securing the adoption by the Legislature of this policy, 
and in the subsequent improvement, enlargement and 
extension of the work, his services have been of the first 
importance. Indeed, the commanding value of his connec- 
tion with the Commission and the loss it will sustain m 
the severance of his relations to it would be difficult to 
over-estimate. Dr. WacDonald's entire professional life 
has been spent in the special field of psychiatry, and he 
has attained the highest honors in the gift of the State in 
his department of medicine. 

How his retirement is viewed by those best qualified 
to judge, viz.: the State hospital superintendents, appears 
from the following, adopted at a meeting of representatives 
of the ten State hospitals: 

Whereas, The superintendents and representatives of 
the State liospitals of New York, in conference assembled, 
have learned with deep regret of the contemplated retire- 
ment of Dr. Carlos F. MacDonald from the presidency of 
the State Commission in Lunacy; therefore, 

Resolved, That as representatives of the State hospitals 
for the insane, we deem it appropriate and fitting to make 
public acknowledgment of our appreciatior] of the important 
service rendered by Dr. MacDonald on behalf of the estab- 
lishment, upon a permanent basis, of the policy of State 
care for the insane, and of carrying out that policy into 
practical operation in an efficient and economical manner. 
Wt- :tls(i record our regret that Dr. MacDonald has found it 
necessary to withdraw from the service of the State in th«t 



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98 Editorial. 

capacity; and we tender him the assurance of our confidence 
in the administration of lunacy affairs by himself and his 
associates. Our thanks are due to him for his efforts to 
promote the welfare of the insane and the successful con- 
duct of the State hospitals, and for his future prosperity 
and success he has our heartiest wishes. 

A copy of these resolutions, handsomely engrossed on 
parchment, was presented to Dr. MacDonald, together with 
an elaborate and costly solid silver punch bowl. 

Dr. Wise, the new president of the Commission has 
given a quarter century to service of the State and the 
care of dependent insane. In 1873 he was appointed assist- 
ant physician and in 1884 he was promoted to the medical 
superintendency of the Willard asylum. In 1889 he accepted 
the medical superintendency of the new St. Lawrence State 
hospital at Ogdensburg. The latter institution was con- 
ceived in a most enlightened spirit of progress, and was 
intended to be an exponent of the latest and most approved 
plans of hospital construction and administration. In the 
seven years of Dr. Wise's incumbency, the policy of the 
hospital and basis of its organization has been completed. 
It is recognized throughout the scientific medical world as a 
model of convenience and adaptability for its purpose, and 
has already attained a high reputation as a curative insti- 
tution. Dr. Wise thus brings to his new position a mature 
experience gained in long and active duty in the great 
department of which he is now the head. Dr. Wise was 
highly commended by Dr. MacDonald as his successor and 
the Governor's action in appointing him is most commend- 
able.— Afeiu York Mail and Express, October 3rd, 1896. 

A Physician in the Cabinet.— On this subject 
the editor of this journal desires to repeat, and will con- 
tinue to repeat it till the matter is accomplished, the view 
expressed by him as President of the American Medical 
Editors Association at their Banquet given at Washington 
in 1893, in honor of the Pan-American Medical Congress. 
The sentiment and the argument were then applauded by 
all the editors present. Let the medical press continue 
to enforce its claims and demand its and the people's 
rights in the premises, and the matter of justice to the 
profession and the people will soon be accomplished. 

"If you would make a people great and glorious in the 
arts, in sciences, in literature, in morals, in arms, in high- 
minded men that constitute the safest and best guardians 
of a State, give them good health, encourage their physi- 
cians to be great doctors, not mere nurses and apothecaries. 



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Editorial. 99 

and your medical journalists to be broad-minded, fearless 
men, in proclaiming the truths that constitute and contribute 
to tlie sanitary welfare of mankind, and mal{e men great 
and women fair and good. 

"As a physician, a practitioner of the healing art, a 
teacher of medicine in school and with journal, I dare to 
proclaim that the wisest and best thing this Government 
can do, both for its present and future welfare, for its 
perpetuity and growth among the nations, the most power- 
ful, most beneficent and grandest of governments, would 
be to create a Bareau of Sanitation [Applause], not merely 
to keep out foreign epidemics of contagious diseases, but a 
psychical and physical sanitation of the many forms of 
disease of body and mind known to science and modern 
medical progress, and recognize the profession of medicine 
as it does that of law. of agriculture and arms, by giving 
the most distinguished and capable of its votaries a proper 
and deserving place in the Cabinet of the Nation. 
[Applause.]" 

The MedicO'Legal Journal continues to show its 
accustomed vitality and vigor in its special line. Its talented 
editor, Wr. Clark Bell, is to be congratulated on his con- 
tinuing energy, enthusiasm and ability in a cause so near 
to that of medicine. This able periodical has now reached 
No. 2 of its sixteenth volume. A glance at the table of 
contents of any number will disclose its value to the student 
of forensic medicine and especially to the alienist and 
neurologist. The following is the contents of the number 
for September, 1896: 

Group pf Promfnent Members of the Medko-Le^al Congress; "Suicide 
(Continued)," by Dr. L. Forbes Winslow, Of London; "The Case of 
Czynski." by Hon. Morltz Ellinger. of New York; "Commitment of the 
Insane in New York," by Albert Bach, Esq., of New York; "Commitment 
of the Insane," by Ralph L. Parsons, M. D.; "Credible Witnesses and 
Circumstantial Evidence," by Sophia McClelland, of New York; "The 
Future of Railway Surgery," by Clark Bell. Esq. , of New York, 
Toxicologlcal : "Inhibition of Strychnia Post-Mortem," by Geo. B. 
Miller, M. D., of Philadelphia; Arsenical Poisoning and Circumstantial 
Evidence. Psychological; Psychological Section Medico-Legal Society; 
Report of Woman's Committee in Case of Mrs. Maybrick, Caroline J. 
Taylor, Chairman: "Narcotic [nehriates," by J. B. Mattlson, M. D. 
Criminal Anthropology: "Kleptomania," by Prof. Lacassagne; English 
Prisons and Irish Political Prisoners. Medico-Legal Surgery. Editorial: 
The Medical Agnos'ic— Compulsory Vaccination.— Hospitals for Railways. 
— Railway Relief Cars.— Russian International Congress. — Physicians In 
Paris. — Italian Society ol F re ni atria.— Photography In Detecting Crime.— 



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Medico-Legal Society of Belgium. Personal. Judge Calvin E. Pratt and 
Portrait. Recent Legal Decisions. Journals and Books. iVlagazines. Books, 
Journals and Pamphlets received. 

Dr. William F. Drewry who for several years past 
served as senior assistant physician to the Central Virginia 
Hospital for Colored Insane, has been promoted to the 
position of superintendent to fill the unexpired term of Dr. 
Barksdale who resigned on account of ill health. 

Dr. Frank Wilfred Page has been appointed sup- 
erintendent of the Vermont State Insane Asylum, to succeed 
Dr. Gidbings, 

The Value of a Knowledge of Neurology. — 

The Boston Medical and Surgical loumal of December 24, 
1896, contains an editoral on the above subject which is 
pat and so in accord with neurological and clinical observa- 
tion, that we take pleasure in presenting it entire with our 
unqualified endorsement: 

The ms|arlty of medical students seem to regard the subject of neurology 
as something metaphysical and mysterious, a field apart from that of the 
rest of the science of medicine, and one which is only cultivated by persons 
of a peculiar squint-brained mould who devote themselves to It more to 
beguile the tedium of an elegant leisure than with any serious Idea of 
benefiting humanity. They scoff, moreover, at the limited scope of its 
therapeutics, and attempt to stifle Its raison d'etre with the sneering remark 
that "All you can do Is to give iodide— and a bad prognosis;" and they 
even go so far as to glory In their profound ignorance of nervous disease, 
and studiously avoid the clinics. 

It should be impressed upon such men that In so thinking and doing 
they are thereby really throwing away the most splendid opportunity which 
Is offered to them throughout their whole medical course, nl tr.iining the two 
faculties most essential to the suc;essful physician— the facullies »i obser- 
vation and of logical induction. 

The trouble with most students who are placed before .i i:linical case is 
that in Retting at historical data, they lail to eliminate the irrelevant, and 
mass tlif essential; and. secondly, that tliev are too prone to jump at con- 
clusions concerning a single organ without giving due consideralion to the 
organism as a whole. 

To eradicate such defects falls peculiarly wilhm the p()wer ol the 
neuroloj-ical Instructor; for the very nature of nervous cases, with their 
unlimited multiplicity of symptoms, is such ns lo educate his p.jrceptlve and 
reasoning faculties to the highest degree, and thus enable him to impart a 
clearer insight into the working of the human machine, energized and regu- 
late.l as it Is by the great cerehro-spin.il .ipnar.itus. than is possible to the 
workei in any other field of the science. 



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Editorial. 101 

His distinctly neurological habit of careful and exhaustive examination, 
with its attendant systematic array of findings and logical inferences 
therefrom, cannot but have a profound influence in shaping the course ol 
the future physician's work in a way which will at once distinguish it trom 
the ordinary and sloven. 

Moreover, it cannot be argued that such a training will make a man 
see everything from a neurological point of view; it is too broad and 
thorough. On the contrary, it will enable the future surgeon to be some- 
thing more than a mere mechanical factor in operative cerebro- spinal dis- 
eases, a position which certain surgeons most conspicuously occupy al 
present. It will impart to the man o( gynecological proclivities a more just 
appreciation ol nervous phenomena which are only too Irequently incorrectly 
attributed to uterine diseases, and enlarge his tield of vision beyond a 
single organ and Its adnexa; and. linally, it will rid the man who is to 
follow the path of general practice of that most senseless notion that the 
nervous system Is a thing apart, and teach him to note the marks of its 
influence either as a valuable ally or as a treacherous antagonist in every 
case he meets. 

One of the most important reasons for the narrow scope ol nervous 
therapy as regards organic diseases is that many such cases are, when in 
their curable stages, in the hands of a family physician, and the vague but 
unequivocal signs which they give are through his indifference — or ignor' 
ance — overlooked. This ts especially true ol Ihat large class of nervous 
diseases which is the result of the virus of syphilis. 

As regards the cases which are really chronic from the start, a practical 
knowledge of neurology will enable the physician to alleviate suffering even 
If he cannot .:ure and, what is of chiefest importance, prevent him from 
exaggerating the disease by indulging in a wholesale and irrational exhibi- 
tion of strychnia, bromides and iodides. 

There Is absolutely no reason why the sufferer from incurable nervous 
disease should not obtain at the hands of his medical attendant the same 
solicitude and studied attention to the alleviation of symptoms as does 
the victim of chronic heart, lung or kidney trouble, but that he generally 
fails to get either Is a fact which obtains and will continue to do so until a 
broader and more rational knowledge of neurology is, by compulsion, if 
necessary. — incorporated into the general mass of medical information 
which is required of the men who leave our medical schools. 

Medico-Legal Society. — A regular meetinti of tltf 
Psycliological Section was held at the residence of Ur. 
HarrietteC. Keatinge, New York Citv, October 26tli. 1896, at 
7:30 o'clock. P. M. 

Sh<irt papers were read by Prof. W. Xavier Siiddiith, of 
Chicago, Chairman of the Section ; Sidney Flower, Esq., of 
Chicago; Dr. U. O. B. Wingate, of Milwaukee; Jas. R. 
Cocke, M. D., of Boston; Tlinmson Jay Hudson, LL. D. ; 
Clark Bell, Esq.; T. U. Crothers, M. D. 



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The regular programme was suplemented by short talks 
•n psychological subjects by invited guests. 

The American Bleetro-Tberapentic Assooia- 
tioB. — The Sixth Annual Meeting of this Association was 
held in Allston Hall, Boston, Mass., September 29th. 30th 
and October 1st, 1896. A full programme was presented. 

Soatbern Surgical and Gynecological Associa- 
tion. — The Ninth Annual Meeting of this Association was 
held in Nashville, Tenn., Nov. 10, 11 and 12th, 1896. Among 
the many interesting papers read, the following were of espe- 
cial interest to the alienist: "Acute Mania Following Surgical 
Operations," Joseph Price, M. D., Philadelphia, Pa. ; "Mental 
Complications Following Surgical Operations," J. T. Wilson, 
M. D., Sherman, Texas. 

The next meeting of the Association will be held in St. 
Louis, in November, 1897. 



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REVIEWS, BOOK NOTICES, ETC 

OVER THE Hookah; the Tales of a talkative doctor, by g. Frank 
Lydston. M. D., Professor ol G en ito- Urinary Surgery in the Chicago 
College of PhyslcfansandSurKeons; Professor of Criminal Anthropology 
in the Kent College of Law, etc. Sold by subscription only. Sent pre- 
paid on receipt of subscription price. Price in doth, gilt top, $4. 00. 
Price in morocco, full gilt, t5.00. Over 600 pages octavo, profusely 
illustrated from the author's designs, by C. Everett Johnson. The Fred 
Kline Publishing Co. Chicago. 
' Among the subjects discussed therein In the author's own Inimitable 
style are; "Several Kinds of Doctors;" "Apropos of Several Subjects;" 
"How a Versatile Young Doctor Reported a Society Event;" "The Doctor 
Emulates Sandow;" "Seeing Things;" "The Rhodomontade of a Sociable 
Skull;" "A Martyr to his Passions;" 'Old Abe" as a Musical Critic, — 
Negro Dialect;" "Poker Jim — Gentleman;" "Larry's Contribution to the 
History of Ireland— Irish Dialect;" "The Passing of Major Merriwether," 
and "Sprays of Original Verse." 

This is an excellent volume for diversion, relaxation and Instruction. 
The melancholic doctor, the hypochondriacal doctor, the optimistic doctor, the 
pessimistic doctor — any idnd of doctor, the scientist and the man of letters, 
the jurist, the prelate, the plain citizen, populist, popocrat. democrat, 
republican, sllverite or gold bug — any sort of man or woman may And rest 
for his soul, and la.uEhter for his bones in this humorous book. No book 
like It has ever before appeared. 

Its pathos and instructive features equal its humor. The two chapters 
devoted to the rhodomontade of a social skull are serious, serio-comic, 
scientific and imaginative, reminding the reader of some of the best work of 
Jules Verne. 

"Over the Hookah" lifts Lydston to a high literary plane among 
medical men, and will win him deserved rank and recognition among the 
medical literati of the world. 

THE NON-HEREDITY OF INEBRIETY, by UsIieE. Keeley, M. D, LL. D 
is an unsustalned effort to controvert the prevailing medical opinion that an 
Inherent Instability of nerve elements makes one man constitutionally prone 
become an inebriate under alcoholic potations, whereas another may go 
on for a life-time an habitual drinker and though his system will be undoubt- 
edly damaged by alcohol, he will not become either dipsomaniac oracommiHi 
drunkard. So many have the inherent neuropathic tendency to instability of 
nerve element by reason of the bibulous habits of our ancestors, that uost 
[1031 



,db,GoogIc 



104 Reviews, Book Notices, Etc. 

men under the use of alcoholic liquors as a daily beverage do tinalJy be- 
come drunkards, that the inaccurate observer is apt to conclude that alcohol 
or its compounds makes (he disease inebriety suifiiuris. and that It is not 
due to neuropathic diathesis, but is usually developed. 

The tables of Morel and the records of Belman and others, and the 
teachings ot Rush, and the testimony of Alienism appear to have made no 
impression on the mind ol the author before us. 

It has been 84 years since Benjamin Rush taught that Inebriety was a 
disease and advised its treatment in hospitals, yet we do not note any 
reference to this distinguished American author's contributions to the subject. 

Nevertheless the book ts adroitly written and refreshingly novel. The 
author's discussion of what he calls "the management of the ativism of the 
cell", is a proof of the heredity of inebriety, and a refutation of his position. 
Scott, Foresman & Co., Chicago, Successors to S. C. Griggs & Co., are 
the publishers. 

ARCHITECTURE OF THE BRAIN, ILLUSTRATED. By Wm. Fuller. M.D., Grand 
Rapids, Mich., formerly Demonstrator of Anatomy, McGill College, 
Montreal, Canada, and Professor of Anatomy, Bishop's College. 
This Is an excellent work by a master In demonstrative anatomy. It 
Is an advisable and almost indispensable accompaniment of the author's far- 
lamed anatomical casts of thebrain, with which we have long been acquainted, 
using them to accompany and elucidate cerebral demonstrations, and make 
plain localities in discussing before the class focal lesions of the brain and 

We consider it decidedly the best descriptive text and series of plates 
of the encephalon extant. With this book and Its accompanying plates 
brain anatomy is decidedly easy, and with the addition of the author's 
sectional casts so true to nature, the study of the brain becomes little more 
than child's play. 

DAS CONTRARE GESCHLECHTSGEFUHL {SEXUAL INVERSION). Von Havelock 

Ellis und J. A. Symonds. Georg H. WIgand, Publisher, 2 Undenstras, 

Leipzig, also published In English. 

Our readers are already quite familiar with the ability of Dr. Ellis on 
the subject of sexual Inversion through his able contributions to the ALIENIST 
AND NEUROLOCIST. He therefore needs no further Introduction. The book 
will interest and instruct all clinical psychiaters and all physicians of 
extensive observation and practice. The medlco-tegal student, the lawyer, 
the psychologist and jurist will likewise find Instruction in this work. It 
presents singular phazes In the morbid sexual life of the gtnus homo. 

GENIUS AND DEGENERATION, s psychological Study by Dr. William 
Hirsch, translated from Ithe Second Edition of the German work' Is a fit 
companion to "Defeneration." by Max Nordau, It is somewhat corrective 
and psychically antidotal in its teachings to some ot the most vicious doc- 
trines of Nordau, and is withal far n 



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Reviews, Book Notices, Etc. 105 

D. AppleCon & Co., New York, are the publishers. The book Is very 
appropriately dedicated to Dr. E. Mendel, of Berlin, Professor of Neurology 
In the Royal University. 

A Practical Treatise on Medical diagnosis. For the Use of students 
and Practitioners. By John H. Musser, M. D., Assistant Professor of 
Clinical Medicine. University of Pennsylvania. Philadelphia. New (2d) 
edition, thoroughly revised. In one octavo volume of 925 pages, with 
177 engravings and 11 full-page colored plates. Cloth, S5.00; leather. 
|6.00. Lea Brothers 4 Co., Publishers. Philadelphia and New York. 

Professor Musser's work has achieved the foremost place as a full and 
systematic treatise on Diagnosis. In this new issue will be found a full 
account of all trustworthy advances that have been made In Its department. 
one of the most progressive in medicine. The work has been enlarged not 
only In text, but also in II lustration, numerous handsome engravings in black 
and many full-page plates in colors having been added. 

ATReattse on appendicitis. ByJohnB. Deaver,M.D. ttsclearand 
thorough teaching, its terse and forcible style and the wealth of experience 
which it represents, are not excelled In any similar work. Its illustrations, 
editorials and literary make-up also commend It. Price S3.50. P. Blakiston , 
Son & Co. . Publishers, 1012 Walnut Street, Philadelphia. 

PHYSICIAN'S VISITING LIST for 1897. P. Blaklston. Son St Co., 1012 
Walnut Street. Philadelphia. The improvements made in this List for 1896 
seems to have met with very general approbation, and Blakiston. Son & Co. 
report an increase of sales of more than ten per cent, over those of 1S9S. 

Can Physicians Honorably Accept Commissions from Orthopedic Instru- 
ment Makers? Commissions to Physicians upon the Sale of Orthopedic 
Apparatus from the Manufacturer's Standpoint. By H. Augustus Wilson. 
A. M.. M. D.. Clinical Professor of Orthopedic Surgery in the Jefferson 
Medical College of Philadelphia, etc., Philadelphia, Pa. 

Ueber syphilitlsche dessemlnirte, cerebrospinale Sklerose nebst Bemer- 
kungen uber die secundare Degeneration der Fasern des vorderen Kleinhim- 
schenkels, des centralen Haubenbundels und der Schleifenschicht. Von 
Prof. W, v. Bechterew, St. Petersburg. 

On the Mode of Procedure under the New Lunacy Law of the state of 
New York, with Suggestions of Methods under which its Provisions can most 
easily be carried into Effect, and also of Improvements in the Law Itself. 
By Ralph Lyman Parsons. A.M., M.D. 

The Microscopical Proof of a Curative Process In Tuberculosis: or the 
ReactJMi to Tuberculin Evidenced by Blood Changes Hitherto Unrecognized. 
By Charles Denison, A.M.. M.D., ex-Presldent of tbe American CllinatoH>g- 
ical Association, etc., Denver, Colo. 



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106 Reviews, Book Notices, Etc. 

Some Observations on the Effect of Thyroid Feeding an the Insane. B^ 
Charles G. Hill, A. M.. M. D., Physidan-ln-Chlel to Mt. Hope Retreat; 
Professor of Nervous and Mental Diseases, Baltimore Medical College, etc. > 
Baltimore, Md. 

Gonorrhceal Iritis and Non-Suppurative Gonorrhceal Conjunctivitis and 
their Pathology. By William Cheatham, M.D.. Professor of Ophthalmology. 
Otology, and Laryngology in the Louisville Medical College, etc, Louisville, 
Kentucky. 

Presidential Address before the American Medico- Psychological Associa* 
tion, 1S96. Qjr Association and our Associates. Some Relations Affecting 
Medical Ollicers of Hospitals for the Insane. By Richard Dewey, M.D. 
Chicago. 

Clinical and Pathological Report of a Case of Cerebral Syphilis. By 
George Emerson Brewer, M.D., Attending Physician. City Hospital, and 
Pearce Bailey, M.D. , Assistant in Neurology, Vanderbilt, Clinic, New York- 
Report of Two Fatal Cases of Hematuria, one In Male, from Spinal 
Injury, Traumatic, one In Female, from Primary Epithelioma of Trigone of 
Female Bladder, Pathological. By Thomas H. Manley, M. D., New York. 

The Etiology and Prophylaxis of Functional Nervous Diseases. By John 
Punton, M. D., Professer of Nervous and Mental Diseases, University 
Medical College and Woman's Medical College, etc., Kansas City. Mo. 

Pediatrics; Past, Present and Prospective. By S. W. Kelley, M. D,, 
Professor Of Diseases of Children in the Cleveland College of F^yslclans 
and Surgeons (Med. Dept. Ohio Wesleyan Univ.), etc., Cleveland, O. 

A Series of Articles of Speech -Defects as Localizing Symptoms, from a 
Study of Six Cases of Aphasia. By J. T. Eskridge, M. D., Neurologist to 
the Arapahoe County and St. Luke's Hospitals, Denver, Col. 

On the Treatment of Fractured Shafts of Bone in Children; Simple, 
Complicated and Compound. By Thomas H. Manley, M. D. , Professor of 
Surgery, New York Clinical School of Medicine, New York. 

Report of Thirteen Cases of Multiple Neuritis Occurring among Insane 
Patients. By E. D. Bondurant, M.D., Assistant Superintendent of the Ala- 
bama Bryce Insane Hospital at Tuskaloosa, 

Diagnosis of Chronic Abscess of the Brain. By J. T. Eskridge. M.D. , 
Professor of Nervous and Mental Diseases In the Medical Department of the 
University of Colorado, Denver, Colo. 

The Symptomatology and Pathology of Exophthalmic Goitre. By William 
C. Krauss, M. D., Professor of Nervous Diseases, Medical Department of 
Niagara University, Buffalo, New York. 

The Solvent Properties of the Buffalo Llthla Waters of Virginia. By 
George Halsted Boyland, M. A., M. D., Formerly Professor of the Baltimore 
Medical College, etc., Paris, France. 



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Reviews, Book Notices, Etc. 107 

Some studies of the Blood in the Thyrvid Feeding in insanity. By 
middieton L. Perry, M. D., Assistant physician at the New Jersey State 
Hospital, Morris Plains. N. J. 

The Relation of the Physician to Soda I, Educational and Moral Questlbns. 
By E. Stuver, M.Sc, M.D.. Ph.D., Member American Medical Assoclatian, 
etc., Rawlins, Wyoming. 

Ueber das Knieschelbenphanonen als dlagnostlsches Kennzeichen von 
Nervenlelden und uber andera verwandle Erscheinungen. Von Prof. W. v. 
Bechterew, St. Petersburg. 

A Case af Hysteria with Ataxia Confined to One Leg. By Charles W. 
Burr, M. D , Clinical Professor of Nervous Diseases in the Medico-Chlrur- 
glcal College. Philadelphia. 

Animal Therapy. By Thomas Osmond Summers, M.A., M.D., F.S.S.C, 
London, etc. , Professor of Anatomy and HistoiO£y, College ot Physicians 
and Surgeons, St. Louis. • 

A Report of the Surgical Clinic at the University of Vermont In the Mary 
Fletcher Hospital. By Dr. Noyes, House Surgeon, and Dr. A. M. Phelps, 
professor of Surgery. 

Transactions of the Forty-third Annual Meeting of the Medical Society 
of the State Of North Carolina, held at Winston-Salem, N. C, May 12th, 
13th and 14th. 1S96. 

Acute Rheumatic Iritis: With Cases. By A. Britton Deynard, M. D. , 
Ihstructor in Retraction of the Eye, New York Post-Graduate Medical School. 
etc., New York City. 

The Effects of Emancipation Upon the Mental and Physical Health of the 
Negro of the South. By J. F. Miller, M.D., Superintendi:nt Eastern Hospi- 
tal, Goldsboro, N.C. 

The Effects of Early Optic Atrophy upon the Course of Locomotor Ataxia. 
By Pearce Bailey, M. D.. Assistant in Neurology, Columbia College, etc., 
New York City. 

Prevention of Tuberculosis. By E. B. Borland, M.D., Clinical Lecturer 
Disease of the Chest, Medical Department of the Western University of 
Pennsylvania. 

The Relation of Noises to Public Health. By William C. Krauss, M. D. , 
Professor of Nervous Diseases, Medical Department of Niagara University, 
Buffalo, N. Y. 

Diphtheria. By C. T. Hood, M. D., Professor Mental and Nervous 
Diseases, the Chicago Homsopathic Post-Graduate Medical School, etc. 
Chicago. 

Das Kontrare Geschlechtsgefuhl. Von Havelock Ellis und J. A. Symonds, 
Deutsche Original -Ausgabe besorgt unter mitwlrkung von Dr. Hans Kurella, 
Leipsig. 



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108 Reviews, Book Notices, Etc. 

On Movements of the Eyelids Associated with the Movements of the 
Jaws and with Lateral Movements of the Eyeballs. By Harry Friedenwald, 
A. B., M. D. 

'An Exact Method for Determining the Capacity of the Stomach and the 
Amount ol Residual Contents. By J. H. Kellogg:, M.D., Battle Creek, Mich. 

Arterlo- Sclerosis Among the Insane. By E. D. Bondurant, M.D. , 
Assistant Superintendent of the Alabama Bryce Insane Hospital at Tuskaloosa. 

Feigned Insanity. Report of Three Cases. By William Francis Drewry , 
M.D. , First Assistant Physician, Central Insane Hospital, Petersburg, Va. 

The Bload in Chorea. By Charles W. Burr. M.D., Professor of Dis- 
eases of the Mind and Nervous System in the Philadelphia Polyclinic, etc. 

On the Course and Destination of Gower's Tract. By Hugh T. Patrick, 
M. D., Professor of Neurology In the Chicago Polyclinic, etc., Chicago. 

A Case of Symphysiotomy. Py H. S. Chrossen. M.D., Superintendent 
and Surgeon -I n-Charge of the St. Louis Female Hospital, St. Louis. 

Intrabronchial Medication. By Joseph Muir, M.D., Physician to the 
Lung Department of the New York Throat and Nose Hospital. 

The Physiology of Decussation ol Nerves; a One-Sided Body Means a 
One-Sided Brain. By Geo. M. Kellogg. M. D., Chicago, III, 

Eine seltene Form lokalislrten klonlschen Krampfes. Simulation Unfall- 
neu rose Oder hysterische Schreckneurose? Von A. Eulenburg. 

The Early Stage of Paretic Dementia. By Frank C. Hoyt. M. D.,Su[;- 
erlntendent Iowa Hospital for the Insane at Clarinda. la. 

The Commitment of the Insane and the "Insanity Law" ol the State ol 
New York. By George| William Jacoby, M.D., New York. 

A Case of Tumor of the Thalamus, with Remarks on the Mental Symp- 
toms. By Walter Channing, M. D., Brookline, Mass. 

Procto-Colonoscopy and Its Possibilities; By a New Method. By 
Thomas Charles Martin, M. D., Cleveland, Ohio. 

On Imperative Ideas; Being a Discussion on Dr. Hack Tuke's Paper in 
Brain, 1S94. By Dr. J. Milne Bramwell. 

Two Years' ainical Experience with Gold Soluikins. By Eustathtus 
Chancellor, M.D., St. Uuis, Mo. 

Hypnotism; Clinical Lecture Delivered at the Chicago Polyclinic. By 
Hugh T. Patrick, M. D., Chicago. 

The Ultimate Physiological Units of the Organism. By M. P. Over- 
hotser, M. D., Harrlsonvllle, Mo. 



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Reviews, Book Notices, Etc. 109 

Insanity in the South. By J. T. Searcy, M.D,. SuperintenJent Insane 
Hospital at TuscalCKisa, Ala. 

Remarks on the Causes of Glaucoma. By Lesrtus Connor. A. M.. M.D.. 
Detroit, Mich. 

Contagiousness of Consumption. By J. G. Hopkins. M.D.,of Thom- 
as v tile, Ga. 

Notes on Inguino-Scrotal Cysts. By Thomas H. Msniey, M. D.. Of 
New York. 

Diagnosis of Hystero- Epilepsy, By Hugh T. Patrick, M. D.. Chicago. 
The Diagnosis of Hysteria. By Huge T. Patrick, M. D.. Chicago. 
Hypnotism in Every-Day Lile. ByC. T. Hood, M. D. , Chicago. 
Chorea. By Henry Hatch, M. D., Quincy, III. 



jdbyGoOglc 



,db,GoogIc 



THE 

Alienist and Neurologist. 



ST. LOUIS, APRIL, 1897. 



ORIGINAL CONTRIBUTIONS. 



PSYCHICAL HERMAPHRODITISM. 



A Few Notes on Sexual Perversion, with 
Two Clinical Cases of Sexual Inversion. 



By WILLIAM LEE HOWARD, M. D., Baltimore, Md. 

THE poet says that some truths had better be kept be- 
hind the screen. This statement may be applicable 
to the writings of the poet, but the scientist wants the 
verity of life. The truth is, the evils are, with scarcely an 
exception, old. That which is new is the intelligence which 
discerns and the humanity wlilch renders them. Sexual per- 
version has always played an important role in human life. 
Nor is it confined to the modern life alone. Few general 
practitioners realize the prevalence of distorted genesic in- 
stincts to day, or the important bearing it had on the life 
of the ancients. When this psychical condition is studied 
by the light of history we can congratulate ourselves that 
this vice, and often disease, is no longer a factor that can 
[111] 



jdbyGoOglc 



112 miliam Ue Howard. 

be insiduously admitted as part of a nation's foibles or prac- 
tices, or that it has any role in the life of the normal human 
being. The ancient history of vice and disease is as inter- . 
esting to the scholar as its aetiology and pathology are to 
modern medical men. 

The history of sexual perversion will be a source of 
pleasure to the optimist and instructing to the pessimist. 
Before coming to the clinical study of sexual perversion as 
we see it to-day let us take a cursory glance of the sub- 
ject from an historical point of view. Von Krafft-Ebing* 
has ably shown the influence that sexual life exercises on 
religion, art and poetry. According to his statements there 
does not exist a teal work of art without a sexual basis, 
and he has properly called attention to the fact that great 
poets and great artists, and I might add, great writers, are 
mostly of a sensual nature, and I will further indite, often 
this sensuality partakes of a perverted feeling. There are 
a large number of men that feel themselves attracted to 
other men and boys. This attraction for individuals of the 
same sex is designated under the name of homo-sexuality, 
in distinction to the term hetero- sexuality, which designates 
the normal attraction. The name Lesbian designates the 
love of woman for woman, and was used in this sense by 
Sappho. Westphal t employs the expression sexual per- 
version (Co»lr%re Sexualemfindung) which allows of a great- 
er latitude in dealing with the subject. Westphal's idea is 
that it is not always a question of deviation from the in- 
stinct itself, but of the sensations that make many an in- 
dividual feel that his personality is entirely estranged from 
the sex to which he belongs. We will see this fact clearly 
demonstrated later on in one of my cases. This writer is 
also of the opinion that sexual perversion embraces also 
those cases in which, the sexual instinct remaining normal, 
the individual presents certain tendencies belonging to the 
opposite sex.' It is well here to have a clear understanding 
between perversion and perversity. There is an incised 
and rigorous distinction, and as laid down by Krafft-Ebing 
it is as follows: "We speak of perversion when the sex- 
ual instinct is a perverted instinct, while we speak of per- 



jdbyGoOglc 



Psychical Hermaphroditism. 113 

versity when it is a question of a perverse action, without 
tal<ing into account the motive that has determined that ac- 
tion, whether it be a perverse inclination or any other mo- 
tive, a criminal action for example." Perversion is an in- . 
clination independent of the will, and for which no one can 
be held responsible, at least in the eyes of an impartial . 
judge; on the contrary, perversity, which is manifested in 
the action, must often be placed to the account of the in- 
dividual. 

Pederasty is often used by modern writers when speak- 
ing of homo-sexual love, but this is incorrect so far as it 
only relates to the act which involves imissio penis in anum. 
Pederasty comes from paH^ erastes. "lover of boys;" 
and it is by this term that the ancient Greeks designated, 
in a general way, whether the sexual act was involved or 
not, lovers of boys and young men. 

Sexual perversion exists to-day to a much greater ex- 
tent than the general practitioner realizes. A proper under- 
standing of this abnormal condition is of great scientific im- 
portance and medico-legal interest. The medical man who 
has a clear understanding and conception of the psycholog- 
ical conditions governing the mental and physical attitudes 
of these perverts and inverts, who is known to understand 
their morbid desires, and appreciates their moral palsy, will. 
be astonished at the number which will seek him for relief. 
I do not refe/ to the vicious, to the morally depraved, to 
the male prostitute, to that class which comes under police 
notice, or to the degenerate whose actions are decidedly 
anti-social. Space prevents me from showing where the 
rigorous line should be drawn between these banal and 
vicious classes and the unfortunate psychical pervert. It is 
certain that in sexual perversion we have to deal with well- 
delined pathological phenomena occurring under conditions 
that vary only in circumstances and environments, which 
have always existed at all periods and in all countries. 
Natural laws govern all the phenomena from the first appear- 
ance of sexual life, through its various phases to decadence. 
A close study of the history of cases will show analogies 
which will convince the most skeptical. The invert and the 



jdbyGoOglC 



1 14 William Lee Howard. 

pervert is to be found among the esthetic class. A marked 
feature of this anomaly is the precocity of the sexual 
instinct. Ninety per cent, of these abnormal individuals 
are engaged in artistic pursuits. They are found among 
the painters, musicians, poets, and the writers of erotic 
fulmination. Among Havelock Ellis' thirty-three cases, two 
were physicians. Female perverts depart to a greater 
degree from the normal than do the male. There are more 
female preverts than inverts in my experience. These 
cases of true sexual perversion, can seldom, if ever, be 
seen in hospitals and dispensaries. (I use thp word per- 
vert to cover all abnormal sexual desires, while invert is 
strictly applied to designate the love of one sex for an 
individual of the same sex. In speaking \r\ a general way 
of the subject, perversibn covers all cases). The practi- 
tioner, while he may have them in his office to be treated 
for some extraneous trouble, will not often be made the 
confident of the pervert. These individuals are secretive, 
reserved and obmutescent. As they recognize the fact that 
unless understood they will be avoided, shunned with dis- ^ 
gust, and finally met with social fVcrinffiilnrln. it is not 
strange that their abnormality is seldom recognized except by 
those of similar psychical desires, and to the specialist, 
with whom they are pitiably frank, honest and hopefully 
confident. The genital organs of the pervert are almost 
without an exception normal in appearance .and function. 
The condition of these individuals is a decided psychical 
morbid entity. Some of them do not realize that their 
passions, desires and thoughts are abnormal. It is not easy 
to appreciate the rdle that external impressions and acci- 
dental environments have played in the individual develop- 
ment of these cases. I do not believe that true inversion 
is ever an acquired condition; it is congenital. I will not 
here go into this interesting branch of the subject, but will 
give fully the history of two cases in which I have been 
able to get at definite basis of facts as regards heredity. 
The first case 1 requested to write out for me, in his own 
words, his history, physical condition, and mental attitude 



jdbyGoOglC 



Psychical Hermaphroditism. 115 

and desires. This will better enable us to understand the 
moral status of these unfortunates. 

Case l.— H. W. F., I am thirty years old. Ever since 
I was a small boy of eight or nine I have practised the 
habit of self-abuse. For many years 1 had no idea that 
it was wrong or injurious; when my eyes were opened I 
loathed myself, and have had no self-respect. I have hon- 
estly resolved time and again to break this habit. One 
summer, four or five years ago, 1 remember how earnestly 
I tried to refrain, and was most miserable. 1 had nocturnal 
emissions, which proved far more weakening than the indul- 
gence; had a cough, was melancholy and despondent. I 
never had advice, 1 have simply drawn my own inferences; 
my experience taught me that I could not overcome the 
habit unaided. I could not then, and doubt if I could now, 
go to my doctor and tell him what I write for you. To-day 
I transgress more than ever; the result: I have never 
weighed as much; eat well. 1 sleep about nine hours 
nightly, and have very few spells of that awful despon- 
dency. 1 believe that I have a goodly amouut of conscien- 
tiousness. I loath the practice, but somehow there seems 
to be a hungering, burning desire, crying for appeasement 
so loudly that the voice of reason is drowned. It seems 
almost as if 1 had two beings. When I am my rational 
self 1 .say to myself "the right is well-defmed; the proper 
course is simple," but when the fit is upon me, there seems 
to be only one word, MUST. It must be gratified regard- 
less of consequences. The object of my imagination is 
man. I suppose that men who practice this habit have as 
the idol of their imagination woman. But it is not so with 
me. 1 think that I have the same regard for men as a 
healthy man has for woman. I have loved men passion- 
ately. 1 idolize them. Any licentious thought in regard to 
such I regard as a sacrilege. That love is just as real to 
me as the love of a young man for a woman, though my 
better s; If would tell me how preposterious it was; yet I 
seem incapable of any other. I can define my disposition 
no better than to say that I seem to be a female in a per- 
fectly formed male body, for, so far as I know, I am a 
well-formed man, capable of performing all of man's func- 
tions sexually. Yet as far back as I can remembei, surejy 
as young as five years, 1 seemed to have the strongest pos- 
sible desire to be a girl, and used to wonder if by some 
peculiar magic I miglit not be transformed. I played with 
dolls; girls were my companions; their tastes were my 
tastes; music, flowers and millinery interested me and do 



jdbyGoOglC 



116 William Lee Howard. 

to this day. I have had little sympathy with boys or men. 
It has always been a topic for thought and speculation, the 
abnormal development of man. Any such thought or con- 
versation kindles the fire of passion in my brain. My love 
for a woman is the same that 1 have for a work of art; 
for a statue. I believe that Venus herself would not excite 
a bit of emotion in me. Yet a handsome man throws me 
into a passionate and emotional fit. In the romances that 
I draw for myself 1 always picture myself as a beautiful 
girl. This is not a forced imagination; such dreams and 
fancies come uncalled for in my mind. My childhood was 
loveless, and I often used to reason that I longed for love 
and sympathy. When I first heard that twins were born I 
wondered if I had not lost my mate, such was that ever 
present longing. In my mother's family there were four 
girls and one boy. He was connected with many women; 
having three wives, a!! living. He was very erratic. Of 
the four girls, two never had children, though married young. 
The husband of one of them told me that his wife could 
never have children. I have two sisters and one brother; 
both sisters married over twenty years and childless. Their 
doctor told me that neither of them could have children. 
My mother died when I was six years old. My father was 
addicted to the morphine habit, and wished to be left 
alone. Yes; I love man in the sexual sense; unsatisfac- 
torily? not wholly so; but the voice that haunts, the fire 
that burns, are stilled and quenched for the time, but only 
for a time. Men who have known men thus extraordinarily 
favored are common, * * * When I see some men my 
face flushes; i tremble; my voice seems unsteady and 
harsh; the nerve strain is acute; only by a mighty effort 
do I keep a semblance of coolness. * * * Should 1 
meet a man who said that he was the favored one 1 would 
throw discretion to the winds; I'll follow impulse regard- 
less of consequences, though I should lose my position and 
be forever disgraced. Indulgence will restore me quickly to 
my mental equillbrum. I desire to have the penis placed 
where the female organ would be if it existed. * * * 
I wanted to be an artist but the opposition was greater 
than the determination. I now paint and design during 
my leisure moments. The quality of my voice has been 
so frequently remarked as to annoy me. I have quite a 
stong falsetto voice of considerable compass. I once knew 
a man who would entice boys to his room and expose him- 
self and fondle them. I have no desire that way. I desire 
only handsome and robust men. I do not think that 1 



jdbyGoOglC 



Psychical Hermaphroditism. \\7 

look twice at a man wholly shaven. I do not always 
entertain lascivious thoughts toward them, 1 feel if I could 
only caress, kiss and "love" them it would be the acme 
of happiness. 

We see "in this case a peculiar congenital condition, 
which differs from the generally conceived idea of a sexual 
pervert, in the fact that the idea of sodomy (immissio penis 
in anum) is repulsive. This condition was first pointed out 
by Casper in the l^ierteljahrschrift in 1852. We also have 
in F's statement the idea and suggestion of a female soul 
in a male body. This phantasy {anima muliebris in copore 
virili inclusa) is an old one, first expressed by Carl Hein- 
rich Ulrich, but is an original conception with F; of this I 
am reasonably certain. Such a specious explanation, while 
it satisfies the psychical longings of 'the pervert, has no 
scientific psychological basis. 

Case II. — Mr. W.: age 38 years; occupation, artist; 
referred to me by Dr. C. G. Chaddock, of St. Louis, Mo. 
His father was a prominent physician who died when W. 
was about twenty years of age. He had been a hard drink- 
er; and during the latter part of his life was addicted to 
taking large doses of chloral, and died in an insane asylum. 
W.'s mother died of paresis when W. was an infant. A brother 
is a steady drinker, and another died insane. He has rea- 
sons to believe that one of liis sisters is a victim of sexual 
disturbances. In fact we have a history of a family en- 
dowed with superior mental capacity yet exhibiting lycan- 
thropic stigmata throughout its whole existence and person- 
nel. When W. was about eight years of age the question 
of sex differentiation arose in his mind, and he questioned 
his father regarding the subject. He was erroneously in- 
formed that there was no difference, and from this mislead- 
ing and injudicious instruction W. dates back the psychical 
twist in his sexual character. At school he practiced mut- 
ual masturbation, but went no further in physical contact 
with his schoolmates. He has never had any normal inter- 
course with, or mental pictures of women or girls. So for- 
eign to him is the ordinary attraction of women to men that 
he expresses no desire to be placed in such a mental con- 
dition as to realize this attraction. He wishes to be relieved 
from a very depressing and annoying nervous irritation 
which inevitably culminates in excessive masturbation, and 
is accompanied by salacious thoughts regarding those of his 



jdbyGoOglC 



118 Wiliiam Lee Howard. 

own sex. These attacks occur at intervals of about four 
weeks, an interesting pathological fact, and immediately 
cease after he has manually relieved himself. For several 
days preceding this psychical explosion he is a different 
person; irritable, unable to rest or sleep, and oblivious to 
his other personality. 

We have here a disordinated condition of the mind, or 
what Prof. Newbold calls an "amorphous mind," the dis- 
ordination producing an imperative and uncontrollable desire 
to masturbate; the impulse to act being forcibly accentuat- 
ed by hallucinations regarding the male genital organs. 
During these periods he has no clear consciousness of the 
existence of his normal body, or rather no lucid conscious- 
ness belonging to that body. When he is W. he realizes 
that he is a man, and has all the habits and instincts of a 
man aside from sexual desires, which are then negative. 
When in this condition, if he has any sexual suggestions, 
auto or otherwise, he is transformed psychically into the 
opposite sex. This derangement of personality, with sexual 
inversion as its motif, I do not remember having ever met 
with before. It offers a new field for studies which involve the 
most perplexing of psychological and physiological problems. 

Treatment. — There is but little to be said regarding the 
treatment of the true sexual pervert. As I have stated the 
condition is a congenital one. In the two cases given 
above, and in several others, I have been able to abolish 
the habit of masturbation, subdue the intense despondency, 
and suppress hysterical tendencies, by the use of hypnotic 
suggestion. This mode of treatment has brought about a 
better physical and mental condition, and aside from the 
inverted sensibility, but which now partakes more of the 
social and sentimental aspect, the patients are well and re- 
signedly contented. Drug medication in these cases is ab- 
solutely useless. Suggestion, avoidance of surroundings 
which are apt to produce emotional feelings: such as music, 
art galleries or the theatre, and substantial but nourishing 
diet is all that can be done; and this only with the idea 
of keeping them free from vicious habits and placing them 
in a condition of mental equilibrium, although they still re- 
main psychically inverted. 



jdbyGoOglC 



Preputial Reflex Epileptiform Convul- 
sions, with Report of a Case. 



By ALEX. L. HODGDON, M. D., 

DI)P«nuiry Phyllcinn to Depirtment uf Nervous D<sh»>. CallcEC ol Physlclitni and 
Sureeons. BaUImore. Md. 

r^HIMOSIS, of course, is only one of the many sources 
•^ of reflex epileptiform convulsions. A tooth forcing 
its way througli the gums, causing pressure on the sensi- 
tive nerve filaments; a splinter imbedded in the finger 
exerting deleterious nerve irritation, or an unaccomodated eye 
with its resultant irritant action, might all produce these 
reflex, epileptiform convulsions, or shall 1 not say the 
beginning of true epilepsy? And it seems doubtful if all 
epilepsies are not in a way reflex, from the irritable gas- 
tric nerves, constituting gastric epilepsy, to the tumor, caus- 
ing irritation by pressure on some one or several of the 
functioning centers of the brain, and by the resulting 
symptoms indicating their locality. Gray very aptly, and I 
believe truly, says that Epilepsy is only a symptom.* 
"Our conception of epilepsy will be altered, if at the out- 
set we recognize the indubitable fact that epilepsy is but a 
symptom, just as is a cough or fever, so that epilepsies 
may be divided into those that are due to recognizable 
organic disease, those that are reflex and those that 
we may call idiopathic." If due to some irritant which 
may be removed, why not very carefully try to prevent 
further convulsions in the teething infant, and circumcise 
the epileptic infant with phimosis, for there must be a 
beginning to everything finite, and by removing sources of 
irritation you may prevent the formation of a permanent 

"Nervous and MenUtDluuci." Gray. 

£119] 



jdbyGoogle 



120 Alex. L. Hodgdon. 

lesion, or an intangible condition, such as habit epilepsy, 
both of which may in the end terminate the life of the 
epileptic, lapse into epileptic mania, and may finally 
follow the subject to his grave. We have somewhat of an 
illustration of this habit epilepsy in the rigor of malaria, 
those paroxysms which continue after the miasm has been 
removed from the system, which are dispelled, in some 
instances, by a mental impression, such as turning back 
.the hands of the clock, till after the usual time for the 
chill; only the malarial paroxysms do not seem to produce 
a permanent change in the function of the nerve tissue, 
which may occur in epilepsy. May we not possibly by 
administering proper doses of bromide of soda to the teeth- 
ing infant, and by circumcising the child with phimosis, 
prevent a life-time of misery? These matters should be 
attended to, and it would be well if all male infants were 
circumcised within the first month after birth, taking care 
to cut off all the skin that covers the head of the penis, 
so as to leave it completely uncovered, and so that no 
part of the head can be made to remain covered. If this 
were done it would prevent the occurrence of phimosis in 
the future, even if not present at that time. About the 
only objections that have been urged against cutting off the 
foreskin, is that it leaves the sensitive head of the penis 
constantly exposed to friction against the clothing and other 
rough articles, and another objection made is that the 
exposure to friction decreases to a certain extent the 
sensibility of this very sensitive head. It does come in con- 
tact with the clothing, after circumcision has been performed, 
but after some time, the mucous membrane of the glans 
penis becomes toughened and thicker, and so far as the 
decrease in sensibility is concerned, this is an advantage, 
as the act of coitus is prolonged, the glands of Tyson 
situated near the corona dry up, so that the glans penis of 
the circumcised individual remains dry and clean. I have 
performed the operation of circumcision many times, and 
have seen cases which have been operated upon by some 
inexperienced operators, which were about as badly off 
after the operation as before, on account of not having 



jdbyGoOglC 



Preputial Reflex Epileptiform Convulsions. 121 

removed enough skin. One should not operate on persons 
afflicted with ha.'mophilia, unless the risk incurred from not 
operating, were greater than that from an operation. 
Kobett has said that the glans penis is not exceeded in 
richness of nerves by any other part of the economy not 
excepting the organs of sense, and if so, is it any wonder 
if reflex epileptic convulsions occur in the case of the 
infant or adult af^icted with phimosis, with a quantity of 
smegma imbedded under the foreskin, on the delicate 
surface of the glans, which cannot be wiped off because 
the foreskin cannot be retracted, and is it not a wonder that 
trouble does not wnsue in more cases? The case which I will 
report is that of W. T. , aged, nearly four months, who had 
suffered since one month of age from epilepsy, having had 
a convulsion nearly every day, and has also exhibited a 
great deal of irritability, which he manifested by frequent 
attacks of crying. -Upon inquiry I found that his urine- had 
always passed away in drops, and dribbled away very 
slowly, also that he was passing considerable mucous by 
the anus. When I examined him. 1 found a very small 
preputial orifice, and was led to conclude that the convul- 
sions from which he had suffered, were probably reflex. 
As he had suffered from about three or four convulsions on 
the day when I first saw him, I resolved not to delay 
operating till the following day, but circumcised him that 
night. Since the operation of circumcision was performed 
he has passed his water without difficulty, and his feces 
appealed more natural. I circumcised him Saturday night, 
and he had no convulsions on Sunday, but Monday after- 
noon he had three or four convulsions and a temperature of 
about XOZ/i" Fah. 1 gave a little Bromide of Soda and Ace* 
tanilide, also small doses of Quinine Sulphate. On Tuesday 
the temperature was about 101°, and on Wednesday his 
temperature was normal. He has not had a convulsion 
since Monday, and seems to be very quiet and good-natured. 
It has been a long time since he was operated upon, and 
I have not heard of his having a convulsion since two days 
after he was circumcised. 



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On Intemperance^ Consanguine Marriages 

and Educational Overpressure, as 

Factors In the Genesis of Nerve 

Disease and Degeneration 

of the Race.* 



By SIR FREDERIC BATEMAN, 


M. 


D., 


LL. 


D. 


, F. 


R. 


C. 


P. 


ConsuHlnjt PhyslcFm to ihe Norfolk ind Non.k 
LtK» Socleir Dl N. V. : Uur«il< of Ui 


h Hoipllil: 
.« Acadeny 


ofMidlclntorFnnco. 


r Mfdlto. 



THERE are few subjects that for some years past have 
so much engrossed the pubhc mind, as those included 
in the title of this communication. I propose considering 
how far degeneration of the nervous system may be caused, 
directly or indirectly (that is in the individual himself or 
in his offspring, but especially in the latter) by Intemper- 
ance, Consanguine Marriages and Overpressure in Education. 
Let me say, in limine, that the effects of each of these 
causes have, in my opinion, been greatly exaggerated, and 
it is with the view or arriving at a correct estimate of the 
effects of each of the above causes of degeneration of nerve 
tissue, that 1 desire to bring my views before the New 
York Medico-Legal Society, fueling that there is no better 
arena for arriving at a satisfactory conclusion upon a sub- 
ject alike interesting to the legal and medical profession. 

It is essentially a practical subject, and the practical 
experience of the members of the Medico-Legal Society will 
be extremely useful in aiding a settlement of the much 
vexed question as to how far the above-mentioned causes 

*R«il btloit ih« PjychDioekal SkHoh, Mcdtco-Utal Society, Oct. 8th. 1896. Rend 
beron the Medko-UeaJ Society. Dec. leih. 1896. 

NOTE.— Publlsbcd by courtesy of the Author and (he MtJiie-Lttal Jimnal. 



jdbyGoOglC 



Intemperance and Degeneration. 123 

are responsible for the widely spread neurotic degeneration 
characterizing the close of the nineteenth century. 

Let me begin with Intemperance, ^which was said, I 
believe, by the late chairman of the English Board of 
Lunacy, Lord Shaftesbury, to be the cause of fifty per 
cent, of all cases of insanity. I need jiot say that this 
statement is not endorsed by those most competent to form 
an opinion on the subject. The part which alcohol plays 
in the production of insanity, has for some time occupied 
the attention of the alienist physicians, and has frequently 
been the subjectof discussion at various scientific associations, 
the result of which is that Lord Shaftesbury's fifty per cent, 
has been reduced to fourteen per cent., and by some 
.observers to even a lower figure. Doubtless many cases 
are stated as due to the abuse of alcoholic stimulants, 
where some other distinct influence co-existed. 

In France, M. Lunier, Inspector of Asylums, has shown _ 
that the departments in which the consumption of alcohol 
had increased most, were those in which there had been 
a corresponding increase of insanity, and this was shown 
most strikingly in regard to women, at the period when the 
natural wines of the country gave way to the consumption 
of spirits. 

In Sweden, Dr. Westfelt has lately made a communi" 
cation to tiie Stockholm Medical Society, containing the 
statistics of alcoholic abuse and its results in Sweden, He 
calculates that at least from seven to twelve or thirteen 
per cent, among males, and from one to two per cent. 
among females, of all cases of acquired insanity, are due 
to the abuse of alcohol; and in reference to its influence 
on progeny and race, he shows that a steady diminution of 
the population was coincident with a period when drunken- 
ness was at its greatest height. 

1 now arrive at the consideration of how far intemper- 
ance in parents may cause nerve degeneration in their off- 
spring, and this is a question upon which, perhaps, more 
definite and reliable conclusions can be formed. The sub- 
ject as to how far intemperance in parents injuriously 
effect their progeny was prominently brought before the 



jdbyGoOglC 



124 Frederic Bateman. 

British Medical Association a few years ago, by Dr. 
Fletcher Beach, and there is a general consensus of opinion 
that the abuse of alcoholic stimulants — mark, I do not say 
the proper use of alcoholic stimulants — tends to bring 
families into a low and feeble condition, which thus becomes 
a prolific cause of idiocy in their children. From a report 
on idiocy, by Dr. Howe and other Commissioners appointed 
by the Governor, of Massachusetts to ascertain the causes 
of this calamity in that State, it is stated that "out of 359 
idiots, the condition of whose progenitors was ascertained, 
ninety-nine were the children of inveterate drunltards"; and 
the report goes on to say-f«rther, that when the parents were 
not actually habitual drunkards,vyet amongst the idiots of the 
lower class, not one quarter of the parents could be con- 
sidered as temperate persons. From the table drawn up by 
the late Dr. Kerlin,- an American physician, in which the 
_ causes of the infirmity are given in 100 cases of idiotic 
children, 1 observe that in thirty-eight of the number, intem- 
perance on the part of the parents is traced as an acces- 
sory, main, direct, or indirect cause. 

At the annual meeting of the British Medical Associa- 
tion, held at Cambridge, Dr. Fletcher Beach read a paper 
on the "Intemperance of Parents as a Predisposing Cause 
of Idiocy in Children." In 430 patients, he was enabled 
to trace a history of parental intemperance in 138 cases, or 
31.6 percent.; of this number sevenly-two were males 
and sixty-six females." 

Other observers lay less stress upon parental intem- 
perance as a cause of idiocy. Dr. Wilbur found that out 
of 365 cases in the State of Illinois, only eight cases were 
assigned to the abuse of drink in tlie parents; and Dr. 
Shuttleworth could trace tliis cause in only 16.38 per cent, 
of the cases observed by himself and by Dr. Fletcher 
Beach;* the same writer under the head of toxic idiocy, 
mentions the case of an idiot boy, who was said to have 
been brought up on porter instead of milk. It will there- 
fore be. seen that there exists a great difference of opinion 

• "Men tally -delicl«ii( Children. th«lr TniiniFnt mi Tnlnlne." By U. E. S1iu(ll«- 



jdbyGoOglC 



Intemperance and Degeneration. 125 

about the influence of intemperance of the parents in the 
causation of idiocy; but although statistics may vary upon 
this point, there cannot be a doubt that the children of 
drunken parents inherit an unhealthy system, which in 
many cases culminates in idiocy. 

Idiocy is especially prevalent in Norway, and Ludwig 
Daht, a Norwegian writer, says that to the abuse of 
brandy, especially in the fathers, but also in the mothers 
during pregnancy, may be assigned an important, perhaps 
the most important, influence in the production of the 
large number of idiots in that country. 

In considering this question, we must bear in mind 
that intemperance is only a relative term; for in the early 
part of the century we read of our ancestors indulging in 
a bottle of port wine to each individual, without, it seems, 
incurring the charge of drunkenness. There cannot be a 
doubt, however, that the habitual use of alcohol, without 
being carried to the extent of actual intoxication, is cal- 
culated to cause a low and feeble condition of the body, 
and thus conduce to the production of idiocy in the off- 
spring; for we may fairly assume that what too severely 
tries the nervous system in one generation will appear in 
tlieir descendants.* Without, therefore, exaggerating the 
influence of alcohol on the genesis of idiocy, 1 think 1 shall 
not be deviating from the path of strict scientific accuracy, 
if i say that over indulgence in alcoholic beverages is 
calculated to produce a low state of vitality, and a degen- 
eration of nerve tissue which may culminate in the develop- 
ment of idiocy in subsequent generations. 

Just now that the attention of the Legislature is being 
-prominently called to the treatment of habitual drunkards, 
it cannot be too widely known that their innocent offspring 
are but too frequently the victims of the brutish excesses 
of their parents, who, a few years ago, were well described 
by the then Secretary of State for the Home Department, 



Touuencl. ■ French writer sayi. "La plupart dei Idloli »nl d« enlints pmcri^t di 

puiJaDeUc qui ■ 9titiii k leur coiKtpilon." 

Al idlicuiilon at (be ObiMirlcal Socltlv. Dr. Lintdon Down It reported lo ha 
*ni*r1alned ilnllar view*. 



,db,Googlc 



126 Frederic Batematt. 

when receiving a deputation on the subject, as not quite 
criininals nor quite lunatics, although nearly approaching 
both classes in many cases. The above statistics fully 
corroborate the pertinency of Lord Cross' remarlts. 

1 do not allude to these facts with the view of casting 
any reflection upon the poor, honest, and temperate laborer, 
who may be afflicted with the calamity of having an idiot 
child; but I merely mention them in order that they may 
serve as an additional caution against habits of intemper- 
ance, and may strengthen the hands of that noble band of 
philanthropists who are endeavoring to check the torrents 
of this hideous vice so prevalent in the present day. 

I would refer those who may wish to pursue the inquiry 
as to the baneful influence of alcohol on the human frame, 
to the celebrated Cantor Lectures on Alcohol, by my friend 
Sir B. W. Richardson, in which he introduces the physio- 
logical argument into the temperance cause, asserting that 
alcohol cannot be classified as a food; that degeneration of 
tissues is produced, that it neither supplies matter for con- 
struction nor production of heat, but, on the contrary, 
militates against both. 

Consanguine Marriages. — There is no point connected 
with the causation of degeneration of the nervous system 
that has given rise to so much controversy as the marriage 
of near relations; formerly one of the most popular notions 
was that consanguineous marriages were among the most 
common causes of idiocy, whereas the researches of later 
observers have tended to modify, to a considerable extent, 
this sweeping assertion. 

Different observers have furnished different results, as 
to the proportion of idiots found to be the offspring of con- 
sanguine marriages; thus Dr. Grabham's statistics give the 
proportion as about two per cent., Dr. Langdon Down's 
rather more than five per cent., and Dr. Shuttle worth's 
less than five per cent. The statistics of the Eastern 
Counties' Asylum, kindly supplied to me by Mr. Turner, 
the Resident Superintendent, show that about 6.5 per 
cent, were the offspring of cousins. 

Of 359 cases observed by Dr. Howe, seventeen were 



jdbyGoOglC 



Intemperance and Degeneralion. 127 

known to be the children of parents nearly related in 
blood. The history of these seventeen families, the heads 
of which being blood relatives intermarried, showed that 
there were other causes to increase the chances of an 
infirm offspring, besides that of intermarriages, as most of 
the parents were intemperate or scrofulous ; some were 
both the one and the other. There were born unto them 
ninety-five children, of whom forty-four were idiotic, twelve 
others were scrofulous and puny, one was deaf, and one 
was a dwarf! In one family of eight cliildren, five were 
idiotic* 

That eminent clinical observer, the late Professor Trousi- 
seau,''' in treating ot the influence of co^^LLnJ;uine marriages, 
gives the history of a Neapolitan family, in which an uncle 
married his niece. There had previously Ix-cn no hereditary 
disease in the family; of the four childrt'u, the issue of 
this marriage, the eldest daughter was very eccentric; the 
second child, a boy, was epileptic; the tliird child very 
intelligent; and the fnurth was an idiot and epileptic. 

Dr. Ireland, who lias investigated this point with great 
minuteness, pertinently remarks that it has luen the cus- 
tom to collect instances of cousins who have married, and 
have had unhealthy children, as if this never happened to 
anyone else; and he adds that "the proper way to examine 
the question clearly is to find what is the proportion of 
marriages of blood relations in a given population, and then 
to Inquire if there be in tlit? issue of such marriages a 
larger percentage of insaiie, idiotic, or otiierwi'^e unhealthy 
children."! 

There c;innot be a doubt that consanguinity has hitherto 
been considered too great a factor in the production of 
idiocy, and that in weighing liie evidence, we must not 
lose sight of the fact that in many casts recorded, other 
factors besides intermarriage of relatives have ajntributed 
concurrently to the development of the m.-ntal delect. 

Educational Overpressure .^\ now proceed Ki consider a 

■ "On Ihc Ciu.eiol Idlocv." Uy S. G, Uu»c, M. D. I'aiiv .IS. 
I "On lJk«y 2.D* Imbedlliy." By W. W. IrelunJ. M. P. I'Jiri.- 1->- 



jdbyGoOglC 



128 'Frederic Bateman. 

cause of social degeneration, which is attracting much 
notice at the present day, especially amongst English-speak- 
ing people, which has been pointed out by Dr. Seguin, and 
which he says is due to the unsatisfactory social conditions 
under which women of the present day exist. "'As soon," 
he says, "as women assumed the anxieties pertaining to 
both sexes, they gave birth to children whose like had 
hardly been met with thirty years ago.* 

Great prominence has lately been given to this subject 
by an oration on "Sex in Education," by Sir James Crich- 
ton Browne, at the Medical Society of London, in which he 
called attention to the "growing tendency to ignore intel- 
lectual distinction between the sexes, to assimilate the 
education of girls to that of boys, and to throw men and 
women into industrial competition in every walk of life." 
Elsewhere, he adds, that "to throw women into competi- 
tion with men is to insure to them a largely increased 

liability to organic nervous disease Woe ' 

betide the generation that springs from mothers amongst 
whom gross nbrvous degenerations abound." Sir J. C. 
Browne supports his views by showing that there are 
organic cerebral differences between men and women, and 
that therefore tliey must be educated in different ways, 
being di'stined to play different parts in the stage of human 
life. 

Sir J. C, Browne, in speaking of the brain of men and 
women, says there can be no question of inferiority or 
superiority between them any more than there can be 
between a telescope and a microscope; but they are differ- 
entiated from each other in structure and function, and fitted 
to do different kinds of work in the world. He maintains 
that the weight of the brain is less in women than in 
men, that the specific gravity of the gray matter is less, 
that the distribution of the blood varies in the two sexes 
to a considerable extent, and that the blood going to the 
female brain is somewhat poorer in quality than that going 
to the male brain, and contains four millions and a half 



jdbyGoOglC 



• Intemperance and Degeneration. 129 

corpuscles to the cubic millimetre, instead of five millions 
in the case of the male. 

The above views of Sir J. C. Browne have not remained 
unchallenged, and 'the eminent psychologist has found 
uncompromising opponents in Mrs. Garrett Anderson and 
others, who stoutly refuse to recognize the position of the 
"Tacens et placens uxor" of old-time dreams. Mrs. Ander- 
son, who, I need scarcely add, writes most temperately 
upon this matter, in alluding to Sir J. C. Browne's assump- 
tion of the intellectual difference between men and women, 
remarks: "All I would venture to say is that, if it could 
be proved that an average man differs from an average 
woman as much as Newton differed from a cretin, it would 
still be well to give the cretin all the training which he 

was capable of receiving When we hear it 

said that women will cease to be womanly if they enter 
professions or occasionally vote in parliamentary elections, 
we think that those who conjure up these terrors should 
try to understand women better, and should rid themselves 
of the habit of being frightened about nothing." 

It seems that one of her own sex is of a different 
opinion to Mrs. Anderson, as in a series of articles in the 
"Nineteenth Century" for 1891 and 1892, Mrs. Lynn Linton 
strongly deprecates any departure from the comparatively 
restricted area of usefulness hitherto open to women, and 
she even boldly states that it is for maternity that women 
primarily exist! She also adds, "be it pleasant or unpleasant, 
it is none the less an absolute truth — the raisan d'etre of a 
woman is maternity .... the cradle lies across the 
door of the polling booth and bars the way to the senate." 

The controversy is continued in the same serial by 
Mrs. Mona Caird, who in a powerful article, entitled 
"Defense of the So-called Wild Women," severely criticises 
Mrs. Lynn Linton's views as to the restrictions she would 
impose upon the freedom of women to choose their own 
career. 

The Hmits of this essay will not permit me to dwell 
at any great length on the important question under con- 
sideration. There cannot be a doubt that the tendency of 



jdbyGoOglC 



130 Frederic Bateman. 

the present age is to encourage women to choose careers 
and to accept burdens unfitted for them. In thus expressing 
myself, I distinctly deprecate any hostility to the woman's 
movement at the present day, which rests on the claim for 
women for an open career; and I should he glad to see 
our universities ignore the ancient and exploded prejudices, 
which led to long subjection of women to hardsliip and 
inequality. They ask for the same facilities as are enjoyed 
by men, and they have amply shown that they can com- 
pete with men in intellectual pursuits, and all they ask is 
to be allowed to compete on equal terms. 1 therefore 
cordially welcome the gradual emancipation of women from 
comparative subjection to comparative freedom ; but the 
multifarious fields of energy and usefulness open to modern 
women, have brought with them disadvantages as well as 
gains. 

Whilst, therefore, unreservedly admitting the claim of 
the fin de sHcle woman to freedom of action and to intel- 
lectual equality, I must think there are certain branches 
of study, described by a modern writer as belonging to the 
"gynagogue" class, which are less suited to women than 
some others; and amongst these, I would name the abstruse 
study of mathematics, for although success in this branch 
of knowledge may lead to a brilliant career as a high 
wrangler, I think that a female mathematical athlete Is not 
suited for the duties and responsibilities of maternity, and 
that the mental endowments of her children are likely to 
be below the average. 

1 am quite aware that I am treading on dangerous and 
delicate ground, but although I would not discourage the 
highest aspirations of women, whether of an intellectual, 
social, or a-sthetic character, i must think- that a word of 
caution is necessary against the overpressure of the present 
day in the direction above indicated. With every desire 
to treat this question from a most liberal point of view, I 
desire to emphasize the fact that men and women have 
different parts to play on the stage of life, and should be 
trained differently; but provided mental overpressure is 
guarded against, I have no fear of women engaging in cer- 



jdbyGoOglC 



Inltmperance and Degeneration. 131 

tain occupations which custom has not hitherto recognised 
as feminine, and experience has shown us that they may 
be safely left to follow the promptings of their own powers 
and instincts. 

Although the injurious effects of overpressure in educa- 
tion have been principally referred to in the education of 
girls, the same pernicious results may accrue in the case 
of boys. Dr. Wynn Westcott,* in his work on "Suicide," 
states that during the last few years there have been several 
English cases of children killing themselves because unable 
to perform school tasks. He also says that child suicide is 
increasing in England and in almost all Continental states, 
and that the cause in many cases is due to overpressure 
in education. Dr. Strahan,t writing upon the same subject, 
in his treatise on "Suicide and Insanity," corroborates Dr. 
Westcott's views, and remarks that fifty years ago, child- 
suicide was comparatively rare; but that during the last 
quarter of a century" it has steadily increased in all Euro- 
pean states, and that the high-pressure system of education 
is generally considered the cause of it. 

If any apology be needed for dwelling at such length 
on the evils of the educational overpressure so prevalent in 
our days, I would observe that it has an indirect bearing 
upon the causation of idiocy ; for although the sinister 
results recorded by Drs. Westcott and Strahan may be 
comparatively rare, still consequences of a more remote 
character may ensue, for the injury done to the nervous 
system is cumulative and transmissible from generation to 
generation, and a neurotic tendency may be engendered in 
the offspring of those who have been exposed to this 
evil, which may manifest itself in the appearance of idiocy 
or some lesser form of mental defect. 



jdbyGoOglC 



WHAT IS MENINGITIS?* 



By W. S. CHRISTOPHER, M. D., Chicago, 111. 

Fellow of the ChloEO Acadxify of Midlclru: Profeisor o( DIsmhs of ChlldKn. 
ChlcAKo Polyclinic. 

THE object of this paper is to call in question certain 
theories regarding meningitis which are very generally 
accepted. These theories are, that symptoms found during 
life in meningitis, result from lesions present in the men- 
inges. Very naturally the definition of meningitis must be 
called in question, and it becomes necessary to ask 
what is meningitis? The question has occurred to me 
almost entirely from a clinical stand-point as will be seen 
by the following cases: In children a vast number of 
so-called brain symptoms occur in a host of cases of great 
variety. Nearly all febrile diseases present more or less 
brain symptoms, but the classical picture of meningitis, 
that is to say, cases in which there occur coma, eye symp- 
toms and symptoms involving various other muscles than 
those of the eye, vomiting, then convulsions, are the ones 
1 shall discuss in considering meningitis. 

Meningitis varies materially in the semeiology which it 
presents. Sometimes with the simplest symptoms, fatal 
meningitis will ensue, and sometimes with the most severe 
symptoms, recovery will occur. 

Some six years ago last month I saw a child fourteen 
months of age, which presented this group of symptoms. 
For four weeks it had diarrhcea of a putrid type. It took 
four weeks to cure the gastro-intestinal derangement at 
which time there was left an emaciated little baby with 
marifed enlargement of the mesenteric glands that could be 



jdbyGoOglC 



IVfiat is Meiiiiigi/is? 133 

readily seen tlirougli the tliin, lax abdominal w;ill. Dr. 
Henrotin asserls that the chM iindoiibteJIy h;id ttiberciilnsis. 
A few days later the child had returned to its febrile con- 
dition and there was presented a picture of photophobia, 
strabismus, irregularity and sliiggish reaction of the pupils, 
irregular respiration, irrejjiilar pulse, and the most marked 
type of hydrocephalic cry to which I have ever listened. 
These symptoms lasted for n week ultimately terminating 
in recovery. 

One would say of course there -was a basilar meningi- 
tis presumably presenting all the a'tiological factors of a 
tubercular type. Five years have elapsed and the child is 
practically well. I saw her recently and found a tendency 
to stumble. I could never make out any paralysis or any 
particular weakness of the muscles, and this tendency to 
stumble may have been a clumsy habit. I mention this 
case for what it is worth. The child is absolutely free 
from gland enlargement, and from any evidence of tuber- 
culosis, so that if she had tubercular meningitis, she made 
a complete recovery. That she had a basilar meningitis 
seems certain. 

I shall next cite a case of the very opposite type. A 
child born in December, 1894, was taken sick in July of 
1895, with slight fever, the nature of which was never 
discovered. It was presumed to be "lii grippe." This 
fever lasted a few days, but the child never seemed exactly 
the same. In August it was found that the mother's milk 
was insufficient and it was suggested to wean the child. 
Before the mother had made up her mind to do so the 
child refused to take the breast. It was then put on ster- 
ilized milk and refused to take this. I saw the child some 
time later and all I could find wrong witli it was persistent 
refusal to take food. It would sit up with a most stern 
and determined expression, upon its face, the little lips were 
tightly closed, absolutely refusing to allow anything except 
water to pass the lips. There was no evidence of nausea 
and no vomiting. It was suggested, however, that meningi- 
tis might occur. The child went on in this way for three 
weeks during which time it received not over a pint of 



jdbyGoOglC 



134 IV. S. Christopher. 

sterilized milk by the mouth. Latterly it was fed by mouth 
with peptonized and sterihzed milk and within twenty-jour 
hours thereafter it presented a picture of meningitis. "The 
symptoms consisted of strabismus, photophobia, general 
convulsions and retracted abdomen. In short there was a 
typical classical picture and so-called symptomatic meningi- 
tis. The milk was perfectly sterilized, the mother and her 
family were absolutely free from tuberculosis as was also 
the father of the child. Not a servant with a suspicion of 
tuberculosis had lived in the house. 

It is interesting to compare two such cases as these: 
One presenting for a period of three or four weeks simply 
a symptom of refusal to take food and terminating after 
twenty-four hours with a complete picture of meningitis; 
the otiier presenting a classical picture of the disease and 
terminating favorably. It fias been my experience that the 
cases presenting classical pictures of meningitis do not termi- 
nate favorably. Very few of them recover so that 
when the classical picture of meningitis is present it is an 
extremely unfavorable prognostic sign. The disease is dan- 
gerous to life, and life is usually sacrificed with the pres- 
ence of such symptoms. 

Another case occurred in my practice January, 1895, in 
the child oi a physician. It was about fourteen months 
old. The child had been bottle fed, hut been fed very 
carefully. Its nutrition seemed perfect. The character of 
its food had been such as to secure for it good nutrition. 
No defects of any kind could be seen in its nutrition, no 
evidence of a rachitic condition, no evidence of scorbutic 
starvation, no evidence of failure of nutrition. About 
Christmas time in consequence yf a little indiscretion in 
feeding the child, there developed putrid diarrh<ea, which 
later improvt-d, but (Inally became worse until about the 
middle of January. At that time 1 saw the child. Its tem- 
perature was 103^. It was somewliat stupid hut manifested 
no sign of meningitis, other than stupor which 1 did not 
look upon as meningeal in the absence of other symptoms. 
There was a rose rash over the abdomen, but not of a type 
to indicate typhoid. Without the slightest hesittition typlioid 



jdbyGoOglC 



iVhat is Meningitis? 135 

fever was excluded. At first it was concluded that there 
was simply a condition of fermentation in the bowel, a 
gastro-enteric intoxication, and in all probability the matter 
could be straightened out by proper attention to the bowel. 
However this proved erroneous. The bowel was cleaned 
out, the fsces rendered relatively aseptic and still the fever 
continued. While it was doubtless true that this child had 
originally had an infection of the bowel contents.it was unques- 
tionably true now that it had general infection of the blood, 
which infection probably had found its way into the circulation 
through the medium of the bowel. The febrile symptoms 
continued and gradually there developed evidences of men- 
ingeal trouble. The stuporous condition continued until the 
1st of January, at which time the child became somewhat 
brighter and more irritable. The nutrition continued good. 
About 21st, sleep was broken and the hydrocephalic cry 
occurred. The child was given one-fourth grain Dover's 
powder to control the pain in the head. There was Aupor 
following this dose, but it was thought at the time that it 
was due to other things than opium. On the morning of 
the 24th, there was a stuporous condition. The abdomen 
was somewhat distended, and enemata were given to relieve 
the bowel distention and to flush the kidneys. The case 
ran along in this way until about January 30th, when the 
stools were of a dark greenish color like chopped spinach. 
For four or five days there was no diarrhcea. Urination 
copious enough; hydrocephalic cry; the child was under 
the influence of opiate. Apfaiently some photophobia, con- 
vergent strabismus for several days preceding cleath, ina- 
bility to bring the left arm across the body, although it 
could reach back of the head to seize the ice bag .and pull 
it away. There were evidences of paralysis of the left side 
of the body, the left leg absolutely motionless while the 
right was kept In constant motion. The left arm it never 
attempted to pull across the body but could rajse to the 
head. The character of the movements of tlie left arm 
indicated some form of paralysis. Expressions of pain were 
developed on lifting the lower part of the trunk with the 
hands under the head. There was a hypera'sthetic condi- 



jdbyGoogle 



136 tV. S. Christopher. 

tion of the left leg and some rigidity of the spine. This 
disappeared somewhat when the strychnia which was given 
was discontinued. Tlie child was kept on strychnine .lo 
grain every three or four hours, but the condition did not 
entirely disappear. The temperature reached normal a few 
days preceding death. Sponging was sufficient to reduce 
the temperature, no other anti-pyretic being given. The 
pulse throughout illness remained strong. January 30tli 
there was considerable distention of the abdomen with 
ineffectual strain which was relieved by massage. The 
temperature then was 103°, when sponging reduced it to 
100". The child sank into quiet slumber about 3 o'clock 
in the morning, when it was found to be in a dying con- 
dition. The child died, but before death there was ameliora- 
tion of the meningeal symptoms, 

I was satisfied toward the close of the child's illness 
that the bowels were clean and the administration ot the 
milk did not seem to increase the trouble in any way. 
Furthermore diuretics were used very largely for the purpose 
of flushing the bowel and of getting fluid into the general 
system as a means of general elimination. Fly blisters 
were applied to relieve the symptoms. Autopsy was made 
by Dr. Futterer. I told the father that the child had died 
of an auto- intoxication which produced marked brain symp- 
toms. Evidences of meningitis were shown by the ordinary 
lymph exudation thrown out upon the meninges. All the 
symptoms were not produced by the single cause. Some 
symptoms consisting of external manifestations were readily 
detected during life while others consisting of internal mani- 
festations were detected only by examinations of the body 
after death. I believe that the exudation upon the men- 
inges was a symptom produced by a certain form of poi- 
soning which was co-ordinated with stupor, convulsions, 
etc., not that' the exudation upon the' meninges held to 
the external symptoms, the relation of 'cause and effect. 
The object of the autopsy was not to overthrow or confirm 
diagnosis, but to find symptoms which did not exist before 
death. The autopsy siiowed the brain absolutely free 
from exudation. There was nothing in the shape of con- 



jdbyGoOglC 



What is Menineitis? 137 

gestion of the meninges or of the brain which could be 
called pathological. There was slight lesions of Peyer's 
patches and of the follicles of the large intestine. There 
was slight thickening of the small intestine but no ulcera- 
tion. The right kidney was in a state of acute congestion 
but there was no change in the left kidney structure. 

Dr. Futterer cited at the autopsy a certain paper read 
in Germany, entitled "Meningitis without Meningitis." In ■ 
other words, an individual had died with the symptoms 
similar to those which I have described, but at autopsy no 
sign of structural lesion were found. I have not had the 
opportunity of looking up this paper. 1 asked Dr. Futterer 
if he had ever seen a case of anatomical meningitis with- 
out the symptoms of it during life. He said "no." 

1 had the good fortune to see such a case within two 
week at the Maurice- Porter Hospital. A child 14 months of 
age had pneumonia, and I saw it at 6 o'clock in the after- 
noon. I had just left the death-bed of a child of the same 
age, who had died of pneumonia. For about a week and 
two days preceeding death it had distinct evidence of cere- 
bro-spinal meningitis. The child died about 3:30 o'clock in 
the afternoon. At 6 o'clock I saw the little one. Although 
there were no meningeal signs present, the general charac* 
ter of the pneumonic process reminded me so much of the 
case just lost. I asked the nurse to be careful to note any 
sign which could be referred to meningitis. I declined to 
put the child upon strychnine, which is the routine treat- 
ment in the hospital. The child was poorly nourished, 
very rachitic and in a bad condition generally. The prog- 
nosis was unfavorable. While it was stupid it was never- 
theless able to follow the finger with its eyes. There was ' 
no photophobia; normal reaction of the pupils; no opistho- 
tonos nor stiffness of any muscle of the body. In other 
words there was a complete absence of meningeal signs. 
When I reached the hospital the next morning the child 
was dead. In the meantime Dr. Quinlan had seen it, but 
found no evidence of meningitis. An autopsy was made 
and disseminated pneumonia found with exudated lymph 
covering practically the whole brain. The lymph covered 



jdbyGoOglC 



138 U^. S. Christopher. 

ttie meninges particularly in the region of the medulla. 
The cord was not opened. Although there was extensive 
exudation of lymph, yet there was not a single medullary 
sign present — no interference with respiration nor with the 
pulse that could be attributed to the exudation upon the 
medullary meninges. This case shows that the classical 
lesions of so-called meningitis can occur without the pro- 
duction of a single symptom referable to that condition. 

So far as I know there is no positive proof that an 
exudate upon the meninges can produce symptoms because 
of its location. The belief that such is the case is great 
because of the coincidence of the two conditions. Here is 
a single case where the 'exudate occurred without symptoms, 
which throws doubt upon the supposed causative relation 
between such an exudate and the symptoms which usually 
accompany it. In other words we have a case of meningitis 
so far as symptoms go, clinically speaking, which at the 
post-mortem table presents absolutely no evidence of the 
clinical and morphological lesions. This is something not 
uncommon. We have been told that when we do not find 
meningitis after death there has been a mistaken diagnosis. 
I believe that it is an incorrect position to assume that we 
should go into the body after death to find what other 
symptoms have been produced by the noxious causes a't 
work besides those which we can detect by clinical means 
of investigation. It lays open the whole question of the 
sufficiency of morphological pathology. Take pneumonia for 
instance. It was defined when I was a student to consist 
of exudation of the lungs. It would be absurd to make 
such a definition now. Pneumonia is an infection produced 
by the pneumococcus and in the course of the life history 
of this germ there occur certain symptoms by the intoxica- 
tion which it produces. Among those symptoms are eleva- 
tion of temperature, sudden onset, hot skin, rapid respiration, 
interference with the action of the heart, dyspnrea and 
exudation into the lung tissue of a fibrinous substance. It 
is believed by some that it is the exudate into the lung 
tissue which produces the rapid respiration and dyspncea in 
cases of fibrinous pneumonia. 1 do not believe it. Why? 



jdbyGoOglC 



iVhat is Meningitis? 139 

Because in bronclio- pneumonia where not a twenty-fifth 
part of the lung tissue is thrown out of active op^ation 
dyspnoea is much greater. Even when we cannot find the 
slightest trace or sign of a morphological lesion by physical 
examination in the broncho -pneumonia, the dyspnoea is 
severe. On the other hand I believe that we can have 
so-called lobar- pneumonia in a child without symptoms at 
all. Not a few cases of this type have come under my 
observation. 

A child nine years of age was found to be a little warm 
by his father who asked me to see it. The child had a 
little cough three or four times during the day, and it was 
believed that there was something wrong. I saw the child 
in the evening and made a careful examination of the throat, 
skin and pulse, etc., and found them normal. I also exam- 
ined the upper lobe of the right lung and found it solid. 
There was a slight elevation of the temperature but no 
acceleration of the pulse. The child was extremely angry, 
because during the next few days I compelled her to stay 
in the house. It was found that the child had fibrinous 
pneumonia which ran its course, resolved and was absorbed. 
I would therefore repeat that it cannot be the mechanical 
feature in the pneumonia which produces the dyspncea but 
a toxic condition. 

We have been having quite a number of cases of 
cerebro- spinal meningitis, two cases of which disease occurred 
in my practice quite recently. A child two years of age 
was taken with tonsillytis, which on examination was found 
to be due to the pneumococcus. About the fourth day of 
the disease I had the opportunity of seeing the child when 
the iiTfection of the throat had disappeared. But there was 
then present the signs of a fibrinous pneumonia. The entire 
posterior half of the left lung was absolutely solid. There 
was no question as to the exudate, and there were distinct 
evidences of cerebro -spinal meningitis, I saw the child a 
second time and found developing on one leg a bluish dis- 
coloration, which I learned subsequently terminated in dry 
gangrene. The child had a pneumococcus infection of the 
tonsil followed by secondary pneumococcus infection of the 



jdbyGoOglC 



!40 »^. S. Christopher. 

lung and meninges and death. An autopsy was not made 
in this case, but the chances are that the symptoms of 
meningitis which consisted of an eijudate of the meninges 
were present in that case. The other symptoms were pres- 
ent and death followed. If we look upon these cases as 
infection with the pneumococcus we can conceive that the 
intoxication might produce gangrene of the extremity. 

Another case, five months old, was taken sick with 
what was supposed to be rheumatism. A diagnosis of 
cerebro-spinal meningitis was made. The condition which 
made the diagnosis possible were, strabismus, opisthotonus, 
inability to move the right leg, which was accompanied by 
slight swelling of the thigh, simulating osteomyelitis with 
pus outside of the bone. The child died two days ago. 
Dr. Fenger who saw the case before death was of the 
opinion that the cerebro-spinal symptoms were reflex. This 
child had besides osteomyelitis, cerebro-spinal meningitis. 

In ttie discussion Dr. Gustave Futterer remarked: "In 
reference to the case Dr. Christopher mentioned in which 
1 autopsied, the anatomical findings were follicular enteritis, 
swelling of the patches, with acute swelling of the mesen- 
teric glands. To the naked eye the pia mater was per- 
fectly intact, glassy, no milky appearance and no exudation 
anywhere. From an anatomical standpoint we had to con- 
clude that there was no meningitis. My opinion was that 
there was septic enteritis, and that from it the meningeal 
symptoms had resulted. The paper to which Dr. Christo- 
pher refers was read by Hoffman, of Heidelberg, at the 
International Medical Congress in 1885 entitled, 'Meningitis 
without Meningitis.' He related some cases in which men- 
ingeal symptoms had existed wherein the typical exudation 
was found and only a milky appearance of the pia mater. 
In one statement 1 must correct Dr. Christopher. When 
he asked me whether 1 had ever seen a similar case or 
not, I replied 'yes.' I referred to an interesting case in 
differential diagnosis mentioned by an assistant of Oliv#r. 
The patient seemed to have typhoid fever, hat a diagnosis 
of meningitis was made. At the autopsy which was made 
by myself no exudation was found, but the pia mater had 
a milky appearance. I recalled the case of Hoffman, took 
particular pains to examine them and found extensive cellu- 
lar infiltration. In a general way in reference to the menin- 
geal symptoms we know that other symptoms can exist except 



jdbyGoOglC 



IVhal is Menitt^tis? 141 

those wtiicli produce either a meningeal exudate otherwise 
and they may baffle the most expert clinicians, making it 
exceedingly difficult for him to say whether there is anatom- 
ical meningitis or not. I refer here to tetanus, uraemia, 
septic conditions and rheumatism. In tetanus for instance, 
we have trismus, and of course that aids us in making a 
differential diagnosis, but aside from that the symptoms can 
be exactly the same as those which we encounter in a 
case of meningitis. In tetanus we are reasonably certain 
that it is only an intoxication. Probably the same condi- 
tion obtains in other diseases. I agree with Dr. Christopher 
that it is not necessary to have meningeal exudate to 
explain the clinical symptoms. The more cases of meningi- 
tis we observe the more difficult it is to make a correct 
diagnosis." 

In reference to localizing the lesions in most cases 
this is quite impossible. In a very few instances of men- 
ingeal tuberculosis it is possible to make a correct localiza- 
tion. If we have paresis of the facial nerve, if we have 
symptoms in the lower extremities or if we have a lesion 
of the central frontal convolution we may be able to localize 
it, while in most other cases we cannot do this. 

Dr. Ludwig Hektaen said: 

"Dr. Christopher's remarks dealing more particularly 
with the clinical phenomena of meningitis made it rather 
dilficult for me to discuss the subject very extensively. I 
think that we must grant Dr. Christopher's first proposi- 
tion, namely; that the meningeal symptoms can exist in a 
number of cases of infections and in cases without any 
meningeal lesion. Concerning his second proposition I do 
not think that everything he claimed can be readily granted. 
Before referring more directly to the point, I wish briefly to 
go over the cases the doctor mentioned and to call atten- 
tion to the most particular points with reference to those 
cases. 

The first case might be one of meningeal tuberculosis 
that had recovered. The proposition is somewhat startling, 
but one instance of meningeal tuberculosis with recovery 
has been described by Dr. Futterer. Another instance of 
chronic meningeal tuberculosis occurred in which the symp- 
toms existed for many weeks, finally terminating in death. 
The lesions in this case were retrogressing at the time of 
death, though recovery from the anatomical changes was 
taking place. In the second case, meningeal tuberculosis 
cannot be excluded even though there is no history of 



jdbyGoOglC 



142 W. S. Christopher. 

heredity and even though the manner of feeding the child 
would exclude tubercular infection by way of the food. We 
cannot exclude tubercular infection from inhalation in that 
case^ and then subsequent infection of tiie meninges either 
directly from the lung or bronchial glands; neither can we 
excMde tubercular infection from the meninges through the 
nose. 

In the third case the meningeal symptoms present 
must be regarded as due to some general infection or intoxi- 
cation, but just what sort of general infection or intoxication 
is present we cannot say because no bacteriological exami- 
nation was made. 

In the fourth case we have pneumonia complicated by 
a sero-fibrinous leptomeningitis. This meningitis gives rise 
to no symptoms. Leptomeningitis occurring in the course 
of lobar pneumonia due to pneumococcus infection is of 
rather frequent occurrence. It is my impression that some 
of the cases of meningitis occurring in the course of pneu- 
monia are atypical so far as the clinical manifestations are 
concerned. 

In the fifth case, as near as I understood it, we have 
reason to believe there was pneumococcus infection. A dry 
gangrene of the extremity occurred, and the logical way of 
explaining that gangrene would be that there existed some 
endocardial inflammation due to the pneumococus, and that 
from the endocardial inflammation emboli were detached and 
lodged in the arteries of the lower extremity in that way 
producing dry gangrene. 

In the sixth case there is osteomyelitis, and of course, 
that points to invasion of the blood by micro-organisms, 
and in the course of this general infection meningeal symp- 
toms might really have been developed, inasmuch as Dr. 
Futterer dealt with this point. In many cases of meningi- 
tis, the microscopic ones may be marked, and of these 
lesions particularly in tubercular meningitis the intravascular 
changes may be the most pronounced of all. There may 
be endarteritis with a tendency toward extension in men- 
ingtrai tuberculosis. Recently I have observed some intra- 
vascular proliferation in cases of pneumococcus meningitis." 

Dr. Henry B. Favill: 

"I was particularly interested in the maintenance of 
certain facts offered by Dr. Futterer and Hektoen; yet 
neither of these somewhat opposing contentions seemed to 
represent the final conclusion of Dr. Christopher. There 
can be no question that at this day the clinical picture of 



jdbyGoOglC 



IVhat is Meningitis? 143 

meningitis must be regarded as essentially an intoxication. 
The question is as to what may properly be called men- 
ingitis. The majority of meningites which have come to 
autopsy have been associated more or less with lymph 
exudation upon the meninges; but the very contention of 
Dr. Hektoen and Dr. Futterer is qualified by stating that 
with the extreme microscopic perfection there may be pro- 
nounced microscopic changes. They simply call attention 
to the common method of observation hitherto recorded. 
As clinicians we must agree that intoxication is fundament- 
ally responsible for the symptom group presented by an 
infectious disease. There must be some determining ana- 
tomical factor, and it may be anything from a mere vascu- 
lar disease, as pointed out by Dr. Hektoen, to an intense 
disease manifested upon the meninges. This is not only 
true with regard to meningitis, but equally true of typhoid 
fever and pneumonia. Are we prepared to say, as I heard 
Dr. Fenger fifteen years ago say in making a poit-mortem 
examination, 'No lesion of Peyer's patches, consequently 
no typhoid fever'? If we say that of typhoid fever, we may 
logically sav the same with reference to meningeal tuber- 
culosis. It is not to my mind a satisfactory position, because 
1 consider the lesion of Peyer's patches like the exudate 
upon the meninges as too gross to permit of exclusive reli- 
ance upon it as a means of diagnosis. Our attention is 
called to the distinct difference which exists between an 
intoxication leading to meningeal symptoms of sufficient 
definiteness to warrant the diagnosis of meningitis, and on 
the other hand to infection of the meninges, two pro- 
nouncedly different conditions. From the standpoint of a 
clinician ! must entirely corroborate the observation of Dr. 
Christopher. The feature of intoxication in infectious dis- 
ease is of the greatest importance, and that the anatomical 
lesion must be regarded as, on the whole, due to a certain 
process occurring with variations and possibly of a nature 
at this moment quite beyond our knowledge." 

Dr. Jas. G. Kiernan: 

"One most important question propounded by Dr. 
Christopher is this; 'Do certain clinical symptoms depend 
on the seat of the lesions rather than the character.' In 
psychiatry this position of Dr. Christopher has long been 
established. There are an immense number of cases, some 
of which reach insane hospitals, some of which die outside, 
belonging to this class which there is a crowing tendency 
among alienists to designate as primary confusional insanity 
which are diagnosed meningitis. They have many of 



jdbyGoOglC 



144 M'. S. Christopher. 

the symptoms which are supposed to be characteristic 
of meningitis, yet on autopsy, microscopic and macroscopic 
appearances are absolutely nil. Tlie same thing is true of 
acute mania even with the cardiac complications which 
occasionally occur, pointing to complications resulting from 
the medulla. In the vast majority of cases where lesions 
occur these are the secondary results of a biochemical 
change consequent on the psychosis rather than the reverse. 
This is still more true of acute melancholia. It is excep- 
tionally true of more definite psychoses, like paretic demen- 
tia which may occur without demonstrable lesions. Even 
of the degenerative types, paranoia for example, this is 
true. Cases of paranoia with a well-defined history, with 
constitutional stigmata occur where there is no cerebral 
teratological change, no microscopic or macroscopic change. 
All these things can be explained from a biochemical stand- 
point since in the function of the neurons certain changes 
occur during life, which are not the result of a direct patho- 
logical change in the sense of demonstrable conditions after 
death, but are merely biochemical changes which may lead 
to these. Dr. Christopher has raised the question of the 
curability of meningeal tuberculosis. At one time (my mind 
is now in statu quo) I did believe that a large number of 
cases of meningeal tuberculosis were recoverable. This was 
twenty years ago, before bacteriologic diagnosis was in 
existence. In a number of cases of katatonia or, if you will, 
cases presenting a symptom complex, which is regarded by 
a large number of alienists as katatonia, whatever may be 
the nosological position, meningeal tuberculosis was found 
in a large number of instances which had passed into cal- 
careous changes. In a paper I read on Katatonia,' two 
decades ago,* I narrated a number of these conditions. At 
the time both Meynert and Kahlbaum had found a number 
of similar cases. t A certain number of cases of hydroceph- 
alus undoubtedly do recover. So-called macrocephalic indi- 
viduals are cases in which an increase of the barren 
formation has taken place. One of the most notorious of 
these was Cuvier, whose recovery accounted for his large 
brain. Another case which came under my observation 
(carefully examined by Dr. Spitzka and myself) twenty- 
one years ago, was an idiot, whose brain weighed five 
ounces more than that of Cuvier. The barren tissue com- 
pensated for the old hydrocephalic change. Dr. Christopher 
has done excellent service in calling our attention to the 



D Neurologist. : 



,db,GoogIc 



IVhat is Meningitis? 145 

multitudinous absurdities diagnosed under the term meningi- 
tis. There are a hundred and one conditions, meningeal, 
neurotic, hysteric and otherwise, put in this omni gatherum. 
Under the term meningism, the condition described by Dr. 
Christopher was characterized at the 1896 meeting of the 
Frencii Neurological Society, Dr. Futterer's 'acute delirium' 
case was one of typhomania — a psychosis marked by cere- 
bral change." 

Dr. Sanger Brown: 

"The position which we will reach in our own minds 
regarding this question depends very largely upon the 
theories of cerebration, of the modes of action of the cortex 
of the brain, which we have accepted as most reasonable 
to us. It appears that we have all agreed that acute men- 
ingitis is an infection disease, and further that the essen- 
tia! feature so far as the clinical symptoms are concerned 
is the action of some morbific influence upon the cortex of 
the brain, which evidently gives rise to the essential and 
distinctive features. As has been previously remarked there 
are various toxajmias which have an influence on the cor- 
tex of the brain. Tetanus, for instance, has some influence 
on the nervous syste.n and on the cortex of the brain. 
Scarlet fever or certain forms of it, produce profound impres- 
sions, stupor, while tetanus produces spasm. But these have 
symptoms quite distinct from those observed in meningitis. 
We are accustomed to believe that when the meninges are 
involved in addition to the other symptoms, there is pain, 
photophobia, etc. I have not heard enough yet to convince 
me that I have to abandon the idea that the distinctive 
symptoms of meningitis are due in most cases and mainly 
to the action of a toxin both upon the cortex of the brain 
and upon the meninges. While I do not think it can be 
demonstrated, it looks reasonable to me to suppose that the 
presence of these toxins alone would be sufficient to cause 
the symptoms but not the exudation. In one case particu- 
larly reported by Dr. Christopher there were no symptoms 
during life, yet there was found an exudation of lymph 
after death. It is possible under such circumstances that 
this child was stuporous for some hours before death, and 
is not possible that this exudate found at the autopsy 
might have been thrown out during these hours of stupor. 
It is believed that cases of undoubted meningitis with the 
symptoms of involvement of the cranial nerves get well. I 
think there are facts in pathology and in clinical experience 
which are similar to that." 

Dr. Hugh T. Patrick: 



jdbyGoOglc 



146 W. 5. Christopher. 

"We must all concede that there are a number of 
diseases distinctly classified in our nosology that gives rise 
to so-called meningeal symptoms. It must be the experi- 
ence of every man who sees cases in general medicine or 
nervous disease in consultation that not infrequently vari- 
ous infectious diseases have been diagnosed as probable 
meningitis, particularly those cases in which the practi- 
tioner is unable to make an accurate diagnosis. Pronounced 
meningeal symptoms occur in many diseases. Furthermore 
the best diagnosticians make a diagnosis of meningitis and 
do not find post-mortem evidence of the disease. We must 
concede that there are cases of severe meningitis, not in 
anatomical sense of the word in which death does not 
ensue. Death may ultimately ensue, but patients with a 
profound meningitis may live for a long time, in other 
words, one case may live with a meningitis ten times as 
pronounced as another patient who dies. When 1 was an 
interne we had a child in the service not without cerebral 
symptoms, but no one made a diagnosis of meningitis. We 
found hydrocephalus which was nothing but meningitis 
with an exudate one-fourth of an inch thick covering the 
entire brain. I have seen syphilitic meningitis extending 
to the convexity, at the base also one-fourth of an inch in 
thickness. The patient died with it, but had lived with it 
a short time before death. This class of cases includes 
tubercular meningitis, chronic syphilitic meningitis of the 
brain and cord, diffuse sarcomatosis also occasionally cases 
of syringomyelia extending up to the pons so nearly like 
sarcomatosis, that they can scarcely be distinguished. In 
all such cases the anatomical condition is that of meningi- 
tis. This condition may be extremely pronounced before a 
patient dies. 

"Along with that class of cases I would like to say that 
I saw two cases come to autopsy in the service of Erb of 
Heidelberg than whom there is no better diagnostician. I 
do not remember the diagnosis which was made, but the 
post-mortem in both cases showed cerebro- spinal meningitis. 
Notwithstanding these facts which go to support the hypo- 
thesis of Dr. Christopher I think we can only call it an 
hypothesis. What is needed in this class of case is inves- 
tigation. The meningitis can produce no cerebral symptoms 
aside from the cortex. Pain, delirium, coma, stupor, refrac- 
tion, must come from the involvement of nerve tissue. How 
may the nerve tissue be involved in meningitis.' It may be 
involved by direct intoxication by circulatory disturbances 
and that is about the end of the string. It is here that 
investigation is needed. Dr. Hektoen's investigation per- 



jdbyGoOglC 



iVhat is Meningitis? \A7 

tains particularly to vascular disturbances which is a great 
step in advance. A great deal has been done in the inves- 
tigation of the effect of toxemias on nerve tissue and it is 
here later investigations must come, as well as investigation 
of the vascular structures." 

Dr. Gustav Futterer: 

"Some years ago I dissected a brain in a case of 
delirium acutum and on examining the cortex 1 found opaque 
triangular spots in the brain. After the post-mortem I could 
not see them because after the cortex is laid bare in five 
or ten minutes it is much more difficult to see the spots. 
I furnished microscopic proof that 1 had not been mistaken 
in observing these spots. I preserved the specimens in 
Mueller's fluid, cut them, and made specimens after Weigert. 
Each one of the spots showed itself clearly as it appeared 
in the brain itself. The nerve substance had disappeared 
which was the reason the spots were not dark. I conclude 
from my observation in this case that there was nothing 
specific about this condition of delirium action. I then ex- 
amined cases of meningeal tuberculosis in the same way and 
found at quite a distance from the tubercular lesions in the 
cortex such atrophic spots where the nerve substance had 
disappeared without any cellular infiltration or sign of 
inflammation being present," 

Dr. Sanger Brown: 

"I would ask Dr. Hektoen and Dr. Futterer in regard 
to investigations showing changes whicli occur in the neu- 
rons of the cortex whetlier or not they are familiar with any 
work on that subject more recent than the article of Dr. 
Berkeley,* which stated that alcohol was administered to 
rabbits for a number of months and then they died from 
the effects of it. The cortex was subsequently examined 
and very distinct changes were found to have taken place 
in the neurons, I would ask if such a system of experi- 
mental research is likely to throw light upon the results of 
the inflammation in meningitis." 

Dr. Ludwig Hektoen: 

"In answer to Dr, Brown's question I would say that 
I believe Dr. Berkeley's investigations will stand the test 
of criticism and he has shown by improved methods that 
changes do occur in the ganglion cells in the cortex of the 

•Johnt Hopkins Hospllal R>pan. 1846. 



jdbyGoOglC 



148 IV. S. Christopher. 

brain as well as the condition referred to by Dr. Brown. 
Furthermore I believe similar processes will show marked 
changes in the cells in a large number of other pathological 
conditions." 

Dr. Brown: 

"As melancholia and dementia."' 

Dr. Hektoen: 

"I am not able to speak particularly of those condi- 
tions, but of meningitis without meningitis, of conditions in 
which there are marked meningeal symptoms in general 
intoxication and infection." 

Dr. John Ridlon: 

"I have been very much interested in meningeal 
tuberculosis, and also in the statement of the cases that 
have recovered. I was taught that all such cases died, I 
thought they did until I encountered some cases that did 
not terminate fatally and then I wondered whether my 
diagnosis was correct. My position has been strengthened 
and I think now that my diagnoses were correct. More than 
half of my patients suffer from tubercular joint diseases and 
certainly three-fourths of all the cases die either of menin- 
geal tuberculosis or general tuberculosis. 1 have only seen 
three cases where a diagnosis of meningeal tuberculosis was 
made and the patients did not die. The first case was seen 
in St. Luke's Hospital, New York City, during my service 
as interne, the child suffering from tubercular spondylitis 
who developed the classical and typical symptoms of men- 
ningeal tut>erculosis, A diagnosis of this disease was made 
by Dr. Newton M. Shaffer and Dr. Andrew H. Smith in 
consultation. A full dose of castor oil relieved the symp- 
toms of tubercular meningitis. I created a life long enemy 
by asking the next day had the child died, would it have 
died of tubercular meningitis.' 

The second case I saw was a patient of Dr. Samuel 
Wood on Long Island, a very superior general practitioner. 
The case was seen many times in consultation by Dr. Wm. 
H, Draper of New York. Dr. Robert E, Weir and the late 
Dr. D- A. McBride. They all agreed that the case was 
one of tubercular meningitis, consequently an unfavorable 
prognosis was made. The patient is alive but is blind. 
The third case was a patient of Dr. O'SiiIlivan in Hyde 
Park, the child suffering with tubercular spondylitis. I saw 
the child two or three times during a year and it had 



jdbyGoOglC 



IVhat is Meningitis'? 149 

abscess in each buttock. In spile of my urgent request that 
the abscess be let alone. Dr. Sullivan could not withstand 
the temptation of thinking that the abscess must be opened. 
He opened the abscess «nd a week or ten days later the 
child developed the clinical symptoms of meningeal tuber- 
culosis. I saw the child three times during the following 
ten days and at my last visit made an unfavorable prog- 
nosis. I felt that the case would prove fatal from the 
beginning. The child however is alive to-day with no 
symptoms dependent upon any meningeal inflammation, and 
I have since wondered whether my diagnosis was right or 
wrong. I was very much pleased to hear the cases that 
have been cited and to hear it generally stated that men- 
ingeal tuberculosis may occur and the patient not die from 
it." 

Dr. Wm. F. Waugh: 

"It is a Rood rule not to look for an unusual or strange 
explanation of fact when a simple one will. answer. The 
condition Dr. Christopher speaks of may be defined as a 
toxaemia whose starting point was the intestinal canal and 
through failure of intestinal antisepsis the toxicogenetic 
Centers develop in the mesenteric glands, and that such a 
condition results in the production of the phenomena ordin- 
arily attributed to meningitis as a clinical fact of consider- 
able value and it seems to me the value of it was a little 
obscured by Dr. Christopher's explanation as to the cura- 
bility of tubercular meningitis. Niemeyer records the case 
of a child who recovered from the primary attack but died 
subsequently about five years later and at the autopsy 
evidence of the first attack were found. Another physician 
reported seven cases that had recovered under the use of 
iodoform ointment to the scalp. I think it is begging the 
question to claim that cases which recover could not have 
been meningeal tuberculosis. As regards the dependence of 
the phenomena on lesions demonstrated after death, it is 
not necessary that these phenomena should be attributed to 
those lesions." 

Dr. W. S. Christopher: 

"There are a few points I desire to touch upon closing. 
I would first like to nsk pathologists present if it is not a 
fact that the symptoms found in meningitis have been gen- 
erally assumed to he due to lesions. H^s pot .this idea 

been very prevalent?" 

Dr. Futterer: 



jdbyGoOglC 



150 IV. S. Christopher. 

"Do you mean microscopic lesions or those visible to 
the naked eye?" 

Dr. Christopher: . 

"Not altogether," 

Dr. Futterer: 

"We admit that we may have a toxic meningitis with- 
out any visible lesion and I am not sure that we may have 
a toxic condition of the brain which may produce symptoms 
like those encountered in real meningitis." 

Dr. Christopher: 

"I would like to ask Dr. Hektoen whether the anat- 
omical lesion are causative of symptoms of meningitis. I 
do not mean to-day, but was not this opinion held by prac- 
titioners some ten years ago?" 

Dr. HektSen: 

"I believe at that time more stress was laid upon the 
effect of the anatomical lesions in acute infections diseases, 
than now. Now more stress is laid upon general infection 
and general intoxication." 

Dr. Christopher: 

"I do not think I am far from right although our path- 
ologists are beginning to hedge. The essential feature in 
disease years ago was the anatomical condition and out of 
it the so-called expectant school of treatment of internal ■ 
medicine was evolved. 1 have not heard anyone assert that 
the exudate upon the meninges was the reason for the oc- 
curence of the symptoms. If they are not the cause of symp- 
toms which we see during life then we have no right to 
expect to diagnosticate that condition anatomically by the 
symptoms. Meningitis is a disease which has an extremely 
grave prognosis and that prognosis is grave irrespective of 
the lesion present. If the lesions produced no symptoms 
we may ignore them and when we find the symptoms of 
meningitis present, for it is only .then that we can diagnos- 
ticate it, then we make a grave prognosis. The pathologist 
has nothing to do with prognosis. The question is settled 
at the time we get hold of the patient, when we make 
our prognosis upon the condition and symptoms which 
we find during life. When I find a child with photophobia, 
strabismus, coma, muscular contraction and with persistent 
vomiting I make a grave prognosis and it is quite imma- 



jdbyGoOglC 



IVhat is Meningitis? 151 

terial whether the symptoms are produced by one form of 
intoxication or another unless we can diagnosticate the kind 
of intoxication and it be of a type which is remediable. If 
it be an intoxication from the bowel and we can remove the 
source of the poison, the prognosis is favorable. If it be a 
case of intoxication of the so-called rheumatic type and we 
can get the materies morbi through the kidneys the prog- 
nosis is fair, if we have an intoxication from some gen- 
eral infection in the blood which we cannot eradicate, the 
prognosis is grave irrespective of the lesions in the men- 
inges. The prognosis then of meningitis is entirely cUnical. 
The second case which I recorded may have been tubercu- 
lar meningitis. I did not look into tho question because it 
brought up a very much disputed point as to whether cases 
of tubercular meningitis ever recover or not. I do not think 
we have any right to say that the case was or was not one 
of tubercular meningitis. We must simply say that the 
means of correct diagnosis is absent. We have at our dis- 
posal means of diagnosis during life by -which we may be 
able to state with some degree of certainty that a certain 
case was tubercular meningitis and if it recovers we can 
say with some degree of certainty that the case has recov- 
ered. I refer to diagnosis by lumbar puncture. Lumbar 
puncture has been resorted to a number of times by introdu- 
cing the hypodermic needle between the second, third and 
fourth lumbar vertebrae with the child lying on one side and 
withdrawing some fluid or permitting it to run, determining 
the degree of pressure by the manometer and then exam- 
ining the fluid for the micro-organisms which it contains. 
In that way in some cases tubercule bacilli may be found 
in the fluid thus obtained. If tubercule bacilli are found 
we have excellent evidence that the disease is of a tuber- 
cular character. Until we have found the cause of tuber- 
cular meningitis by such means of finding the tubercular 
bacilli in the fluid as I have mentioned we have no right to 
say that a case of tubercular meningitis can recover. At 
the same time we have no right to say that a case of 
tubercular meningitis cannot recover. The question is 
beyond our knowledge to settle because of the absence of 
reliable data. I have had five deaths from meningitis within 
the past two weeks and of these two had pneumonia and 
two bowel trouble. One was a case of osteomyelitis of the 
femur which may or may not have had meningitis." 

Dr. Patrick: 

"How many autopsies?" 

Dr. Christopher: 



jdbyGoOglc 



152 IV. S. Ckristopher. 

"Two. There seems need of some determining factor to 
justify a diagnosis of meningitis. It is, after all, a question 
of terms. I think we are ail agreed that the occurrence of 
the lymph exudate upon the meninges is not enough to 
make out a disease which has the fatal prognosis that men- 
ingitis has. If meningitis is an anatomical condition we 
must admit that we cannot diagnosticate it during life with 
absoljte certainty because the symptoms do not justify the 
exact anatomical condition present. We do find a certain 
number of things clinically which have an extremely bad 
prognosis and it is desirable to use the term meningitis to 
cover them. You may relegate the term meningitis to 
anatomical conditions that are found but if you do you must 
use a different word to describe the clinical conditions which 
are found. As remarked by Dr. Favill we must admit that 
there has been a general collapse of the anatomical condi- 
tion which constitutes meningitis. We no longer need to 
have pus or lymph, we may get along even with simply the 
changes which occur in the arteries or vessels themselves, 
and still have meningitis. The farther we get from the old 
gross lesion of meningitis the farther we are frsm the caus- 
ative symptoms observed. 



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THE CASE OF STURGEON YOUNG.* 



A Question of Hypnotic Injury and Death. 



Reported by CLARK BELL, Esq. 



Abstiacted from Advance Sheets, Medico-Legal Jounial, by 
C. H. Hughes. 



THE Coroner of Chautauqua County, A. H. Bowen, 
M. D., Health Officer at Jamestown, New York, 
held an inquest as to the cause of death of Sturgeon 
Young, a colored lad, who recently died there in Janu- 
ary, 1897, under circumstances that led the authorities 
to regard it proper to investigate the cause of death, 
and how far if was traceable to his condition, as 
affected by the repeated placing of the lad in hypnotic 
state, by hypnotizers who were not sliilled in ttie matter, 
and from which, it was thought, he had sustained physical 
injuries which might have incited the disease of which 
he died, 

I was called upon by the Coroner to aid him in this 
investigation, and- 1 requested him to have a careful and 
complete autopsy made by competent medical men, and the 
inquest was adjourned to enable me to furnish him with 

' ReaJ hclore Ihe Psycholoclesl Stcllon of Itie Medlco-Leeal Sotlety Feb. 10, 1897. 
Rt*d before Ihe Medico-Legal Society. Feb. 20. 1897. 



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expert and opinion evidence bearing upon the questions he 
regarded as important to the inquiry he was conducting. 

He furnished me with such of the facts as had trans- 
pired, a resume of which is given in my letter enclosed 
and with a Hypothetical question, which is subjoined. 

I sent a letter, of which the following is a copy, and 
the Hypothetical question to some of the more prominent 
experts who are members of the Psychological Section of 
the Medico-Legal Society: 

Di3r Sir: — Will you please reply to the following hypothetical 
question? 

In case of a youth seventeen years of age, of good physical develop- 
ment and medical history, well nourished, weighing about 125 pounds, upon 
autopsy with no observable lesion, beyond slight cerebral softening, and 
trace of kidney deterioration, vital organs normal with cause of disease 
diagnosed as diabetes meilitus; and it appearing upon conceded evidence 
that the deceased had for approximately over six months been a chronic 
"sensitive subject" of extreme susceptibility to hypnotic or "mesmeric 
influence:" having been protractedly and repeatedly hypnotized many times 
by amateurs and Irresponsible and reckless youthful operators and dabblers 
In hypnotism; and while under the influence or In a state of statuvolence 
having been sat or stood on, by men of average or heavy weight, while in a 
cataleptic state, with head and feet supported, so that he formed a bridge 
between such supports; and having been thrown Into and left in hypnotic or 
trancoldal states with instructions to emerge therefrom at a given time, and 
upon emerging apparently from such trancoidal state complaining of nervous 
Chill, physical prostration and malaise; In your view and opinion, accord- 
ing to the best of your professional knowledge and belief, according to the best 
authorities and latest research wherewith you are familiar, in physiology, 
pathology and psychology- — -would physical Injury or organic Impairment 
particularly of the renal function, or symptoms of glycosuria, directly or 
Indirectly, follow from the psychic or emotional disturbance or derangement 
of nerve function, involved In or due to, the morbid innervation Incident to 
such hypnotic practice or experimentation in "mesmerism" or alleged 
animal magnetism? 



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The Case of Sturgeon Young. 155 

Medico -Legal Society, 

OFFICE OF THE SECRETARY, 
No. 39 Broadway, 
NEW YORK, Feb. 1st. 1897. 

My Diar Sir and ColltagHt.—\ have received from the Coroner of 
Chautauqua County, a hypothetical question of which I enclose you a copy, 
to which he desires a reply from some of our medical experts ramillar with 
the suhject of hypnotic suggestion. Briefly, the case, aside from the state- 
ment made in the hypothetical question. Is; that this Coroner Is now con- 
ducting an inquest at Jamestown, N. Y., upon the body of a young negro 
named Spurgeon Young, which encites great public interest. Dr. C. J. 
Phillips and Dr. Wm, M. Bemus made the autopsy and subsequently testified 
substantially that, the treatment to which the deceased had been subjected 
while under hypnotic influence, had in their opinion, caused the disease, 
diabtles melhlus which had caused death. The hypothetical question gives 
substantially the results of the autopsy, except that Dr. Phillips testified that 
he found no external bruises or Internal lesions sufficient to cause death 
except as stated in the hypothetical question; that sugar was found in the 
urine, which he stated was the Indication of diabetes, but that the tissues 
of the kidneys were not broken down. He further lesiified that diabetes 
was a kidney or nervous disease that may be caused by strong nervous 
excitement or non-asslmilatjon; and that he believed that the tax upon the 
nervous system had a tendency to cause diabetes, and that acute and 
chronic diseases of the brain of a depressing character, such as mlEhC be 
caused by hypnotism might produce the disease. He further testified that 
hypnotism is sometimes used with beneficial effects in cases of hysteria and 
paralysis, but as it was commonly practiced It was extremely dangerous, 
and that it was a severe strain upon the subject's nervous system. He 
also testified that the first stage of hypnotism might be refreshing, but that 
the further stages might be dangerous. He was cross-examined as to 
whether a subject could be made to commit suicide or crime under sugges- 
tion, upon cases read from medical Journals; and answered that the cases 
were unusual, but that he had no doubt of their truth and was positive that 
hypnotism was a dangerous agency. It was claimed before the Coroner's 
jury by the District Attorney that hypnotism as practiced by amateurs was 
dangerous alike to morals and lives of the subjects in certain cases. 

I have beep appealed to by this public official to aid him as a public 
officer In the investigation of the subject by the opinion of scientitic experts 
connected with this l>ody in aid of the due administration of justice. The 
inquest is adjourned to to-morrow evening and will be further adjourned to 
hear my reply. I therefore ask that you forward to me at once your answer 
to the enclosed hypothetical question, taking into consideration also, as the 
basis of your decision, and opinion such facts as are contained herein, so 
that I may forward your reply to the Coroner, 

Yours hastily, 

CXMtVi BELL, 



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IS6 Clark Bell. 

Thomson Jay Hudson, Esq., LL. D., of Washington, 
D. C, replied as follows to the hypothetical question: 

In reply I have to say: — 

First, that I cannot be considered a medical expert in the true sense of 
the term. I am a lawyer by profession and have ctven some attention in the 
course of my studies to the subject of Forensic Medicine; but not to the ex- 
tent to entitle me to assume the rank of an expert. I have however devoted* 
a large share ol niy time during the hlteen years past to the study of 
theoretical and experimental hypnotism and cognate psychical phenomena. 

My experience and observation in this line of inquiry enables me to say 
definitely and without reference to age, physical development, medical history 
or pathological condition that, given a case where "the deceasei had lor ap- 
proximately over six months been a chronic stnslllve subject of extreme 
susceptibility to hypnotic or mesmeric influence; having been protractedly 
and repeatedly hypnotized many times, by amateurs and irresponsible and 
reckless youthful operators, and dabblers in hypnotism; and while under 
the state of statuvolence having been sat or stood on, by a man of average 
or heavy weight, while In a cataleptic state, with head and feet supported, 
so that he formed a bridge between such supports; and having been thrown 
Into and left in hypnotic or trancoidal states with Instructions to emerge 
therefrom at a given lime, and upon emerging therefrom such apparently 
trancoidal state complaining of nervous chills, physical prostration and 
malaise;" In my opinion there could be but one inevitable result, namely, a 
shattered nervous organism leading eventually, il life is prolonged, to im- 
becility or Insanity. 

What physical ailments might result from an abnormal mental and ner- 
vous condition thus induced would depend largely upon the particular char- 
acter Ol the treatment to which the victim was subjected at the hands ol his 
persecutors, and upon which the letter before me, throws no light. I do not 
however undertake to speak Irom experience or personal observation on this 
branch ol the subject. It Is the province of medical experts to determine 
what particular physical diseases may result from given nervous conditions. 

I may remark, however, that from a somewhat extended course of read- 
ing of the works ol medical experts ol recognized ability and standing in the 
profession, I have been led to believe that there are few bodily diseases that 
may not be produced by abnormal mental and nervous conditions. "Who," 
asks Dr. Tuke,'will pretend to assert that any tissue of the body tsl>eyond 
the range of nervous influence?" 



jdbyGoOglC 



The Case of Sturgeon Young. 157 

I cannot witlifn the limits o( a letter give tUe ratioimit of my convictions 
relating to the disastrous effects upon the victims of unskilled and reckless 
hypnotic experiments. My views upon that subject may be lound, however, 
ffi an article in the current number ol the Hypnotic Magaiim, Chicago, en- 
titled "The Danger Lines of Hypnotism." 

Prof. W. Xavier Sudduth, of Chicago, replied as follows: 
CLARK BELL, ESQ., 

Dear Friend: — In answer to the hypothetical question in the case of the 
deceased negro. Spurgeon Young, would say that hypnotic suggestion or sug- 
gestion given in the hypnotic state is a positive force and its practice in the 
hands of "amateurs. Irresponsible persons and reckless youthful operators 
and dabblers" is fraught with gravt dangers. Cases are on record where 
suhjects In such hands have suffered some nervous shock resulting in serious 
derangement ol the nervous system even from one or a few experiments, not 
from or by reason of the hypnotlzation or the induction of the hypnotic state, 
but by reason of the emotional disturbance Incident to such expaimtatation. 
A close distinction must be made between hypnosis, which is a restful state 
ot somnolence, that can have no bad effects, In and ol itself, and the vicious 
suggestions and practices made to and upon the subject while in the hyp- 
notic state. The bad effects of such suggestions are not alone confined to 
the hypnotic state, however, but are constantly being observed In the waking 
State in superstitious and susceptible individuals with equal or worse results 
than are ever to be observed in the hypnotic state, because with persons In 
the hypnotic state some degree of protection from shock Is insured by reason 
of the general condition passively obtained during hypnosis where hypnosis 
(sleep) alone is Indicated, and the patient left alone he quickly passes from 
the hypnotic sleep, into an ordinary sleep, to awaken sooner or later re- 
freshed by his experience. The nervous chills, physical prostration and 
malaise complained ot In this case on awakening from the somnolent state 
were due not to the state but to the suggestions and practices Indulged in by 
those who had him under control and for which they should be held crimin- 
ally liable. As to the possibility of Inducing diabetes mellilus through emo- 
tional disturbance, I am not so clear, in lact. I am very doubtful whether such 
a condition could be thus brought about and should rather lean to the nega- 
tive side of the question. Disturbance ol the renal function is constant In 
persons suffering from Intense grief or melancholia. Many cases of so-called 
Bright's disease are the result o( prolonged nervous strain and this may 
have been such a case, but on this point I would rather be excused from an- 
swering positively except on more information than is given in the question 
that is forwarded me for answer. If such were the case, however, 1 should 
not attribute it to hypnotism but to the vicious practices and suggestions In- 
dulged in while the subject was under hypnosis. In conclusion. I should like 
to say, that the practice of hypnosis by the laity is to be depreciated in all 
Instances and that laws should be passed by the legislatures of the several 
states conferring its use, not to the physicians alone, but to those physicians 



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Irving C. Rosse, M.D., replied as follows: , 

In answer to the hypoiheifcal question submitted, I should say that In 
my vfew and opinion the glycosuria Is In no way related to the morbid 
innervation brouKht about by hypnotic practice. 

Glycosuria is extremely rare among negroes, Of many hundred I have 
examined lor alleged kidney disease, sugar In the urine was found in but 
one Instance, that o( a messenger in the U. S. Treasury Department. 

Olahetes of traumatic origin and the association ol this disease with 
nerve changes are familiar pathological facts. The neurosis known as 
maior hypnotism Is also a pathological state, since animals become demented 
after frequent subjection to hypnotic influence, and the best authorities are 
that vascular changes In the brain with breaking down of nerve tissue 
associate themselves with hypnotism. Moreover, hypnotized subjects are 
observed to show exaltation of the special senses; over excitability of 
the muscular system, and diminished reflexes. 

The injurious tendency of hypnotic practice to exhaust nervous force 
and weaken the will is spoken of by some authorities as a kind of moral 
masturbation that should be prohibited or restricted by legal enactment. 

The fact of the decedent having been a subject of extreme susceptlhlllty 
to hypnotic Influence affords sufficient ground for the Inference that he was 
also neurotic, and his nervouslsm was aggravated and increased by the 
existing renal Impairment or glycosuria, which was not due or Incident to 
alleged hypnotic or mesmeric expeiiment. 

T. D. Crothers, M.D., of Hartford, says: 

The hypothetical question presented by Mr. Bowen. Coroner of Chau- 
tauqua County, N. Y., contains no facts from which any conclusions should 
be drawn that hypnotism was In any way an exciting or contributing cause 
of death. 

There are no authentic facts on record to support the assumption, that 
hypnotic conditions including catalepsy, trance and repeated hypnosis are 
followed by organic disease ot any kind. Least of all organic impairment of 
the kidney or its glycosuric function. It is possible that certain degenera- 
tion of the nerve centers may be increased by repeated hypnosis, but at 
present there are no facts to prove this. In this hypothetical question there 
could be no connection between rrnal derangement and extreme sensitiveness 
to hypnotic suggestion. One could and would not follow the other. There 
Is no evidence so far, to prove hypnosis pathological. 

The symptoms of debility following such states are not the result to he 
a'trlbuted to it: the derangement ot the kidneys is a chemical and organic 
one, in diabetes, and not from psychic influences from objective sources. 



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TTte Case of Sturgeon Young. 159 

Thts question offers no reliable suggestions along the line o( observed 
(acts up to the present; or Indicates any reasonable possibility of the 
relation of cause and effect In this case. 

Henry Hulst, M.D., of Grand Rapids, Mich., writes: 

I received your letter with the hypothetical question, and will try to 
tonnulate my opinion at once. 

Given an extremely sensitive subject of extreme susceptibility to 
hypnotic or mesmeric influence, protractedly and repeatedly hypnotized by 
amateurs are Irresponsible persons, being stood and sat upon, etc.. subse- 
quent malaise and physical protraction on the part of ttie subject Is not to 
be wondered at, especially as such amateurs and irresponsible youthful 
operators can scarcely be expected to know enough to prevent or remove 
such disagreeable after-effects. 

As to whether synptoms of glycosuria directly or Indirectly follow from 
psychic or emotional disturbance or derangement of nerve function involved 
In or due to the morbid innervation Incident to such hypnotic practice or 
experimentation in "mesmerism" or alleged "animal nagnetism," I must 
say that so far as t know no case of that kind occurs in literature. 

The etiology of Diabetes Mellltus Is still very obscure. It Is produced 
artiflcally In animals by irritating a particular spot In the medulla. Beyond 
that but JIttle is known positively. Osier says that "mental shock, severe 
nervous strain and worry precede many cases." He uses the word "pre- 
cede" not "cause." Our knowledge Of the disease Is too obscure to warrant 
us In concluding that any given antecedent severe nervous strain and 
worry Is the cause In a given case. 

The question whether even the abuse ol hypnotism can cause diabetes, 
it seems to me, ought to be answered in the light of the foregoing. 

To attribute the diabetes to the use or abuse of hypnotism In the case 
on hand, would be; therefore, a mere speculation, and not an opinion based 
upon sdeniii^c observation, cannot be determined from the facts set forth 
In the hypothetical question. 

Henry S. Drayton, M.D., of New York, says: 
Wf Dear Sir;— Your lavor, with enclosed hypothetical question, Is at 
hand this P. M. Just at this time 1 can but give my opinion briefly with 
regard to the Interests Involved. Assuming the premises as stated by Dr. 
Bowen, I have no doubt that hypnotic treatment so practiced by "amateurs 
and Irresponsible and reckless youlhlul operators, dabblers In hypnotism" 
was perilous to such a "sensitive" in both physical and mental side. The 
very fact of a neurotic dyscrasia would Itself render me exceedingly careful 
In employing the hypnotic method should a patient so constituied be brought 
to me for treatment. The old "mesmerists" were pronounced in opinion 
against the experiments of careless and ignorant persons deeming them of a 
dangerous nature, and the more experienced ol modem hypnotists are quite 



jdbyGoOglC 



160 Clark Bell. 

In agreement that nuch Injury may be done by unlearned and unskillful per* 
sons, who attempt experiments in hypnotic suggestion as lor those who 
perform In this wise In public for the sake of gain and notoriety there Is 
little doubt that their extravagant and senseless operations may be produc- 
tive of much hann to the weiker subjects of their manipulation. Regretting 
lack of timt for a better expression of my opIntCn, 1 am, etc. 

James R. Cocke, M.D., of Boston, Mass., replies: 
Dtar Sir; — Concerning the coroner's questions, letme say briefly again, 
that I can readily understand how a person of exceedingly nervous, sensitive 
temperament could be so wrought upon as to Induce an active hyperaemia In 
the mtdulla obtongata, where, as you know, In the floor of the fourth ventricle 
are centers which when disturbed unduly by chemical or other Influences pro- 
duce a glycosuria which might become pennanent if Indammatlon succeeded 
to the state of active hyperaemia. However, I have hypnotized thirteen 
diabetics. Besides diabttts mtUilus these patients suffered from severe sec- 
ondary dermatoses, and in one case the patient suffered severely from der- 
mitltls herpetiformis. In all these thirteen cases I succeeded In relieving the 
pain, dyspnoea, and to a certain extent the polydipsia and bulimia. The hyp- 
notism did not seem to exercise any inhibitory influence over the excessive 
glycogenic fonnation. However, of course, have never been and never will 
be subjected to those ridiculous and criminal performances which have rend- 
ered the name of hypnotism odious In so many places. 

I use hypnotism as a sedative and In these cases find that it makes no 
dilTerence whatever In the amount of solids excreted by the kidneys. The 
revolving mirror and other exciting agencies of the kind will produce temp- 
orary albuminuria with subsequently a very fatal disease in the young. It is, 
of course, attributed, as you know, first, to disease of the medulla oblongata, 
secondly, to disease of the pancreas. The result of the post mortem sent by 
you is so incomplete as to make a decision of the individual case impossible. 
I iKlleve, however, that the so-called hypnotic subject was an hysterical 
subject and that the excessive states of nervous excitation, could have been 
hastened, perhaps precipitated diabetes nuUitus, granting that there was a 
peculiar vulnerability either of the centers of the medulla or o( the tissue and 
other nervous mechanism of the pancreas. DiabeUs miUHui in the young in 
my experience is an aggravated form of disease. The polydipsia and bulimia 
cause such intense suffering as to make It Impossible for a subject to endure 
long the hypnotic experiments described. There is a form of intermittent 
glycosuria which has no etiological basis so far as we can discover. 

Diabelis mtlliliis is not necessarily attended with renal degeneration, al- 
though a secondary nephritis of Che parenchymatous type is often seen In 
cases of long standing. In the young, renal degeneration is seldom exten- 
sive. These conclusions are the result of forty-one post mortems made by 
me and also based upon the authority of Keatlng's encyclopedia, "Diseases 
of Children." 

Prof. C. H. Hughes, of St, Louis, says: 



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The Case of sturgeon Young. 161 

Dt»T Sir and ColUagu*:— Extensive observation of the hypnotic state 
and of the effect of repeated and long maintained hypnotlsin on the same 
subject , has convinced me of the deleterious effect of the of ten -repeated and 
long continued hypnotic state on the nervous systemi of Its subjects, es- 
pecially its damaging effea^on the Inhibitory centres of the brain which reg- 
ulate the normal volitions and the natural spontaneity of the mental 
operations of the Individual. The repeatedly and continuously hypnotized 
subject becomes a more or less changed man as compared with his normal 
state and to this extent, is in an Insane state of mind with this difference from 
the ordinarily Insane person, that his change of mental character is chiefty 
subject to the directing influence of another person rather than to his own 
perverted and abnormal volition as is the case with the ordinary Insane per- 
son. But he may become as Insane and diseased In brain as an ordinary 
lunatic. 

In the case above submitted. I think It not at all Improbable that the 
brain In the region of the fourth ventricle which contains the diabetic centre 
of the brain was damaged by the repeated hypnotisms, and that the diabetes 
Itself resulted therefrom, as puncture of the floor of the fourth ventricle 
causes. In animals, the phenomenon of diabetes or glycosuria, and it is often 
also the result of psychic overstrain. Because of this experimental psycho- 
logical fact of a diabetic center In the brain, and the clinical evidence of 
psychical impressions as In diabetic melancholia, as it Is called, but which 
is the diabetes of the nerve exhausted state of melancholia or melancholic 
diabetes, diabetes and vaso-motor effects and blood congestions are not 
unlikely to result from hypnotic experimentation too long maintained or too 
often made. 

Physical injuries also, doubtless, resulted to kidneys and abdominal vis- 
cera from the violent usage of the subject while In the hypnotic trance state, 
especially while )n the condition of cataleptic rigidity, stretched from chair 
to chair, resting In opisthotonos attitude on head and feet, with persons 
walking on his abdomen or sitting or putting weights on him or pounding him. 

There are other causes of diabetes, however, such as excessive feeding, 
with sedentary habits and discontent, melancholia, etc , In plethoric, inac- 
tive persons. 

1 could not answer this question definitely without knowing whether 
there pre-existed other probable causes of the slight brain softening and 
trace Of kidney deterioration, but the result referred to in the Interrogatory 
Is not impossible after long, excessive and continuous hypnotic Influence. 

Prof. Thos. Bassett Keyes, M. D., of Chicago, writes: 
Yours of February 1st, In regard to the hypothetical question, as to 

whether diabetes mellitus, as In the case referred to of Spurgeon Young, 

might result from improper handling, suggestions and impressions under 

hypnotism, is at hand and briefly considered. 

From what we know of the psychological action of suggestion, after 

hypnotism, it leads me to say that, since blisters have been drawn, hxmor- 



jdbyGoOglC 



162 Clark Bell. 

rhages made to app«ar or stop, sores to heal, inflammation and swellings to 
disappear, glands and organs to become active or slow, according to the 
suggestions; since the tissues In every part of the body may be influenced, 
and from what we koow of the etlolc^y of diabetes mellltus ; viz. , that it is 
sometimes the result of Irritation of the vaso-motor areas o( the floor of the 
fourth ventrical, and since this Irritation may'result from shock, mental 
labor, and strong excitement and emotion, It leads me to say that If 
Improper suggestions were made to a hypnotized subject — such as suggest- 
tion to cause excessive fear or shock, or any but properly directed psycho- 
logical suggestions — they would have a deteriorating or abnormal stimulating 
Influence upon the body and nervous system generally, and such shock, 
deterioration or abnormal stimulation might produce, it seems very probable, 
the disease— DM6/f» Mellifus, or if the subject was improperly handled 
(the suggestions being also considered) a local or central hyperemia of the 
floor of the fourth ventricle might 'be produced. "Mechanical irritation of 
this region produces glycosuria." — Loomis. , .,. . 

Other questions might be considered, as the stlnul^tion of certain 
ganglia so as to produce excessive activity and assloitfatlv^ processes. 

Dr. N. O. B.Wingate, of Milwaukee, Wis., says: 

Dfar Sir and ColUagut:—\ouis of the 6th Inst, received and contents 
noted. I enclose herewith s copy of the hypothetical question which you 
submit to me for reply, and will answer it as follows: 

1 do not believe diabetes mellitus would follow In the treatment, but 
given a case where diabetes mellltus existed, I believe such hypnotic practice 
as related In the question would be decidedly injurious. 

Mr. Sydney Flower, of Chicago, replies: 

Mj> Dear Colleague; —The Coroner's question may l»e condensed, may 
It not? into "Do hypnotic experiments, performed with a subject who Is In 
the cataleptic State, produce physical injury or organic impaimlent in that 
subject?" I should think It most unlikely, and cite In defense of this posi- 
tion two significant facts, namely: 1st, Thi^t there are no instances on 
record of Injury having resulted to anyone by such practice: and 2nd, That 
In the case of a greater weight being placed upon a cataleptic subject's body 
than he Is able to support he will bend beneath It. In other words, cata- 
lepsy is a stiffening of the muscles of the body by voluntary effort under the 
suggestion of the operator; although, occasionally, the same state may be 
induced by the auto-suggestion of the subject. Only a certain small per- 
centage of hypnotic subjects become good cataleptics, and this important 
fact was emphasized by Dr. Parkyr. superintendent of the Chicago School 
of Psychology, when I submitted to him the Coroners question. The point 
he makes in this connection Is thflt f«w people have a natural aptitude for 



jdbyGoOglC 



The Case of Sturgeon Young. 163 

these experiments; and that though one subject may be, while under sug- 
Eestlon, capable of making his body rigid; another may fall utterly. Also 
that while one may stiffen certain muscles of his body, he may not be able 
to stiffen all, and lastly, that the boy who can, while in hypnosis, sustain a 
weight upon his stomach, when suspended between two chairs, can also 
perform the same feat while In the waiting condition, and that the catalepsy 
Is lai^ely dependent upon his habit of life, muscular formation, and training 
or practice in these experiments. Seeing then that a subject who has not In 
himself the muscular power necessary to support a weight, will not do so, 
but will bend under lt,andfthat a cataleptic subject will come out of the cataleptic 
condition and his muscles naturally relax, when the limit of his endurance 
In this direaion Is reached, It becomes evident that a rigidity Is by no 
means the formidable condition It is comoionty represented to be. As I am 
not a doctor of medicine it would be presumptious in me to comment upon 
the finding that this hoy. Sturgeon Young, died of diabetes supposed to be 
induced by his performances while In a hypnotic condition. But i wish to 
know if diabetes manifests itself with the rapidity here Indicated; and If It 
has ever been shown that a pressure upon the abdomen results in a strain 
of the kidneys. 

As to the responsibility in the case, It seems to me that no authority 
upon hypnotism will deny that this boy was conscious of the fact that these 
experiments were to be tried upon him. He was not a persecuted Infant, 
compelled by a stronger will than his own to perform muscular teats which 
were liable to Injure him. He was In the position of an athlete who Is 
willing for applause, or for gain, to test his strength in a certain manner. 
I do not think he injured himself by the performance of these feats, but 
admitting, For argument's sake, that he did, where lies the blame? He 
need not have consented to anything of the kind, but he voluntarily, and of 
his own tree will, knowing well what be was expected to do, undertook to 
perform these experiments. I hB.-ip always denounced somnambulistic per- 
formances which had no scientific aim, as foolish and dangerous. They are 
foolish, because when it is clearly understood that the subject Is a con- 
scious agent, they can have no special interests as experiments, but de- 
pend for their attraction upon the mystery which is ignorantly Impressed 
upon the spectators by the uninformed operator. They are dangerous only 
because of the want of knowledge of the operator In properly removing all 
suggested delusions — but even here, we can only assume a danger to exist. 
There have been no Instances of evil effects resulting from even a careless 
use of hypnotism, and it Is only by inferential reasoning that the best 
writers ctehne the dangers of hypnotism. I think that both the experienced 
and the inexperienced operators are prone to magnify both the dangers and 
benefits of hypnotic suggestion. 

With relerence finally to these experiments, I should place cataleptic 
exhibitions In the "foolish" class, and sense delusions in the "dangerous." 

Dr. Fred. Laidlaw, of New York, says: 



jdbyGoOglc 



164 Clark Bell. 

From the account of tbe autopsy given, it is my opinion that diabetes 
meilitus was the probable cause of death, it is my further opinion that the 
frequent practice of hypnotic experiments had no relation whatever to the 
diabetes. In my opinion, it Is not possible to produce diabetes meilitus by 
the practice oi hypnotism, nor. If the disease is already present, will It be 
aggravated by hypnotic experiments any further than is Involved In the 
general proposition that. In any diseased condition, all exertions that 
exhaust the patient, render him more susceptible to the Inroads of his 

Dr. Jas. T. Searcy, of Tuscaloosa, Ala., writes: 

I think It a very plausible opinion that the disease of Diabetes Meilitus, 
of which, or with symptoms ol which, the young man under consideration 
was said to have died, could have been occasioned, or could have been 
a^ravated to a fatal termination, by the continued and excessive hypnotism 
to which he was subjected during the six months prior to his death. Hyp- 
notism Is always a strain and often a serious danger to the brain, particu- 
larly if carried to excess oi repeated tor months In a case evidently of weak 
cerebral ability as this one seems to have been. In my opinion, sensitive- 
ness to hypnotic suggestion Is always an Indication of cerebral (cortical) 
weakness or abnormality. In that particular and in that way the person is 

Diabetes Is much more a disease of the brain or of high nerve structure 
than of either the liver, which produces the sugar, or of the kidneys, which 
eliminate it. The frequent and severe strains to which, not only the brain 
of the young man was subjected, but also his whole system could have 
occasioned a disease of brain structure, which was the first cause of the 
diabetes, or have very much aggravated it, If, by heredity, or by any other 
cause, it had already begun. 

This answer Is given within the limits of the hypothetical question 
proposed by Dr. Bowen, and does not take Into consideration other injuries 
to Internal organs, which your letter refers to, and also supposes the cause 
of death to have been only the diabetes. The cerebral softening mentioned 
may be the pathological condition o( which he died or may have been the 
pathological source of the diabetes. 

If the diabetes was of sufliclent degree or of suflicienlly long standing 
to have been the cause of death, you could, with great plausibility, advocate 
that It had been occasioned in a subject Inclined to it, and had been aggra- 
vated, after it was begun, by the hypnotism be was subjected to, though there 
is no positive or direct proof, pathological or otherwise, connecting the 
hypnotism with the diabetes. 



jdbyGoOglC 



The Case of Sturgeon Young. 165 

Prof. A. A. D'Ancona.of San Francisco, replies as follows: 

Dear Sir;— Your favor requesting answer to hypothetical question 
asked by the Health Officer of Jamestown, N. V.. is at hand. 

tt seems to me that doctors who conducted the autopsy are under a 
misapprehension regarding the pathologyjol diabetes. The kidneys are not 
the seat ai the trouble. They simply eliminate sugar from^the blood when It 
is in'quantity too great for the needs of the system, 'or In a form not assim- 
ilable by the tissues. The doctors should have examined particularly the 
liver and pancreas. 

i.^lFurthermore, diabetes can not be predicated on account of the presence 
ol one symptom, namely ,''g1ycosuria.JiThis'symptom often cones from mere 
excess of sugars and starches in.the'.food.j^So well recognized is this, that 
the large Life insurance companies IJinstruct^thelr examiners not to reject 
applicantson account ol glycosuria, unless associated with the rational signs 
of diabetes. That it was not so associated. I s3[ probable, 2 first, because the 
hypothetical question Is silent upon the 'subject of the rational signs; and, 
secondly, becauseone of the most marked symptoms of diabetes Is progressive 
emaciation in spile of a voracious appetite and the subject In this case is 
described as "well nourished." 

Though the causation of diabetes is.obscure, many cases have been 
considered to be due 1o nervous shock, emotion., ^anxiety; many to Injury 
and disease of the nervous system, to severe |,mental.'and physical ^strain, 
to blows upon the abdomen, etc, , etc. 

It is certainly possible that ihe experiments outlined In the hypothetical 
question overtaxed the physical and mental powers of the subject. This com- 
bined, with the supporting of heavy weights upon the abdominal walls may 
have produced profound functional changes in the abdominal viscera, diabetes 
being one of the affects. 

It is nevertheless true, that for the majority of cases of diabetes, no 
cause can ht assigned. Owing to the uncertainty of :the etiology of the 
disease, to attribute [positively tiie cause of death to diabetes induced by 
functional nervous disturbance of the abdominal organs, the result of hypnotic 
experiments, however unskillful, seems to be unwarranted. 

Dr. J. D. Buck, of ,Cincinnati,^repUed as^follows: 
In my opinion grave physical Injury would arise from the foregoing pro- 
cedure: Rrst. impairment of the n-rvous system, and Anally Imbecility. See 
reports ol experiments of schools of Paris, Norway and others. Cerebral 
softening and diabetes might result from repeated hypnosis. The practice. Is 
harmful under all circumstances except in ^the hands of_skitirul physicians 
for the treatment of disease, and even then'in a narrow range of diseases 
and with doubtful results. In ail other casus It is dangerous and Should be 
suppressed by law and with severe penalties. 

This liypothetical question and my accompanying letter 
have been sent to other experts of position and prominence 



jdbyGoOglC 



166 Clark BeU. 

connected with the Medico-Legal Society and the Psycho- 
logical Section whose replies are not yet received. 

I have n«t formulated my own opinion upon the case, 
preferring to wait until I shall receive a more complete and 
detailed statement of the autopsy, which, in my opinion, 
should throw all necessary light upon the question pro- 
pounded by the Coroner. 

The case presents some interesting questions and will, 
I do not doubt, excite interest among students of the science 
on both sides of the Atlantic. 

I sent the question to Prof. R. Virchow, of Berlin, one 
of our honorary members and other eminent members abroad 
and the case will serve to call attention to a new field of 
inquiry upon this interesting subject. 

NOTE. — The following additional information was fur- 
nished by the Coroner after the verdict. 

The autopsy was as follows, though it was not furnished to 
any of the experts who replied to the hypothetical question: 
Hxamfnation of body of J. W. Sturgeon Young at the home of his father, 
1033 North Main Street. 

Height, S feet 7 Inches. Age, 17 years. Weight, {estimated) 125 lbs. 
Drs. W. M. Bemus, Phillips and Rice present, also Coroner Dr. Bowen. 
Drs. W. M. Bemus and Phillips operating. 

Rigor mortis well marked. Body fairly well nourished. 

1. Examination of brain, incision from ear to ear through scalp, and 
tissues dissected and scalp reflected forward and back. (4 oz. urine drawn 
by catheter) Coroner went away at 1 p. m. Cranium removed. Brain 
removed. Dura matter, normal. Pla matter and archnoid, normal; some 
small tubercules upon both sides of longitudinal fissure of cerebrum. Brain 
slightly softened on left side of cerebrum. White and gray matter, norouU. 
Weight. 48 oz. 

2. Chest opened. Lungs, normal. Oesophagus and trachea, normal. 
Pericardium, normal. Heart, normal. Weight 8 oi. Valves all normal. 
Diaphram. normal. Liver, weight 3^ lbs., normal in appearance. Bowels 
contained scybata. Stomach, normal, but distended with gas. Pancreas 
small, but normal. Kidneys, left, hardened, small; right, hardened, 
small, with small tubercles In tubules of kidney. Spleen, small, dark, soft. 
Spine, normal; no evidence of external Injury. 

3. Urine. Reaction, slightly add. Sp. gr. 1.020. Phosphates pres- 
ent. No albumen. Sugar in large amount. 

WILLIAM M. BEMUS. 
C. J. PHILLIPS. 
A. B. RICE. 



jdbyGoOglC 



The Case of Sturgeon Young. 167 

The evidence of the attending physician, A. B. Rice, 
M. D., was: 

That he treated YounE ffom January 14, 1897, to the time of his death; 
on the 20th of January, he was contined to his bed and passed very large 
quantities of urine, three or lour gallons per day. 

On analysis the urine was found to contain large quantities of sugar. 
Dr. Rke diagnosed the disease as Diabetes Mellltus. Young complained of 
pain In his back, was very weak, had an Inordinate thirst, voracious appe- 
tite, observed daily loss of strength, but kept his mental faculties, though at 
times he would lapse Into a stupor. 

The verdict of the jury was as follows: 

We find that J. W. Sturgeon Young came to his death at 1033 North 
Main street In the city of Jamestown, In said county, on the 24th day of 
January, 1897, from diabetes and nervous exhaustion caused by hypnotic 
practices performed by the foltowing persons as shown by the evidence: R. 
Louenstein, Daniel H. Grandin, Parke H. Davis, Charles Wood, Edward P. 
Dodge, Robert Bemus; and from the testimony produced before us upon the 
Inquest It appears that the said J. W. Sturgeon Young for several months 
prior to his death had been habitually and continually hypnotized by the 
above-mentioned persons and that while under the hypnotic influence, his 
body was suspended between two chairs, the back of his head resting on one 
chair and his feet upon another without other support and that while so 
suspended a person weighing at least 180 pounds sat upon him; that he had 
also while under such hypnotic influence been carried through the various 
Stages of Intoxication and delirium tremens and other hypnotic feats. 

We would recommend that the state legislature pass a law prohibiting 
the practice of hypnotism. 

I was unable to give an opinion on the hypothetical 
question alone, and did not receive the autopsy or the 
statement of Dr. A. B. Kice, the attending physician, until 
after the verdict was rendered. 

Note. — Though this case is incomplete without a 
careful microscopical examination of the brain and a more 
thorough cHnical record of Sturgeon Young, we give the 
record and opinions place in our pages because this is the 
first case of the kind in court annals of hypnotism or sup- 
posed hypnotic influence in engendering disease in a hyp- 
notic subject.— C. H. H. 



jdbyGoOglc 



ENCEPHALITIC AND LATE EPILEPSY. 



By JAS. G. KIERNAN, M. D., Chicago. 

Foreign Associate Member French Medico -Psychological Association; Fellow 

of the Chicago Academy of Medicine ; Prolessor of Forensic 

Psychiatry Kent College of Law. 

EPILEPSY occurring after 25 and that due to encephalitis 
have points of special interest in common. Epilepsy 
following on the various forms of infantile encephahtis 
exhibits in my experience many peculiarities. It is more 
apt to be accompanied by trophic phenomena of the extrem- 
ities varying from the simple "dead fingers" to phenomena 
nearly approximating Raynaud's disease. Jt reacts badly to 
the bromides. Mental symptoms, fits of temper, of sullen- 
ness, of depression, or even destructiveness, replace under 
the bromides the convulsive attacks. The tendency to 
impairment of the circulatory innervation of the extremities 
is increased. The various bromic dermatoses appear with 
comparatively great frequency. In not a few instances, 
these eruptions have proven unduly severe and protracted. 
A nocturnal mental type takes the place often of the con- 
vulsion. Jt is attended by phenomena closely resembling 
those of somnambulism. In some few instances an intense 
pruritus results. While the dermic phenomena due to the 
bromides yield to arsenic, calcium sulphide, etc., still these 
ameliorations are very temporary and the original phenom- 
ena recur after a time. 

As Spitzka* has pointed out epilepsy is a diseased state 
of the encephalon without a palpable characteristic lesion, 
manifesting itself in explosive activity of an unduly irritable 
vaso- motor centre, leading to complete or partial loss of 
consciousness which may be preceded or followed by various 

•N. E. Medlcil Journal 1831. 

[168] 



jdbyGoOglC 



Encepkalitic and Late Epilepsy. 169 

phenomena expressing the undue preponderance of some and 
the suspended inhibitory influence of other cerebral districts. 
The patho- anatomical changes found in patients suffering 
from this disease throw but little light on pathological phy- 
siology. Certain vascular phenomena accompany an epi- 
leptic attack so constantly that they have been considered 
the fundamental essential factor of epilepsy. Suddenly pro- 
duced anaemia of the higher nerve centers will, it is true, 
produce convulsions. But it does not follow that the arter- 
ial spasm is the direct cause of the epileptic fit. The 
convulsion while a phenomena of the fit, is neither an ini- 
tial nor is it as constant as it should be were the Kussmaul- 
Tenner theory correct. 

Nor does the discharging lesion theory of Hughlings- 
Jackson explain the phenomena of epilepsy. That an irri- 
tative lesion of different portions of the brain may result in 
epileptiform explosions is no proof that the idiopathic epi- 
leptic attack has a similar origin and is due to similarly 
located foci of impalpable disease. Take an inflammatory 
softening on or near the cortical area which stands in a 
relation to the muscle of the arm; epileptiform spasms may 
be a symptom of such a lesion and they may begin in the 
particular muscle whose "center" is affected, they may then 
extend to the other muscles of that half of the body or 
suddenly to the entire voluntary muscular system. Is that 
proof that the epileptic "discharge has extended through the 
cortex by irradiations?" It does not seem that this cpuld be 
maintained in cases where the transition from the localized 
or, as it were, "focal" spasm to the general convulsion was 
sudden. It seems more probable that the primary irritatisn 
had determined a secondary irritability of the great convul- 
sive center of the body, namely, the reticular gray matter 
of the brain isthmus particularly of the pons and medulla. 
Starting with the fact that alt characteristic features of the 
full epileptic onset can be produced in animals deprived of 
their cerebral hemispheres working, a satisfactory hypothesis 
of the nature of epilepsy can be obtained. It needs but a 



jdbyGoOglc 



170 Jas. G. KUman. 

slight puncture with a thin needle to produce typical con- 
vulsions in the rabbit and some of the convulsive move- 
ments reported by Nothnagel have not only shown the true 
epileptic character but also that peculiar automatism noted 
in aberrant attacks, it is in this segment of the nei^vous 
' system that |all the great nerve strands conveying motor 
impulses both of a voluntary and automatic and some of a 
reflex character, are found united in a relatively small area, 
and just here a relatively slight disturbance might produce 
functional disturbances involving the entire bodily periphery. 

The experiments of physiologists have shown that if a 
sensory irritation of a given spina! nucleus be kept up, after 
having produced a reflex movement in the same segment, if 
there is any reaction beyond the plane of that segment at 
all it is not in the next or succeeding planes but in the 
medulla oblongata. The motor reaction then manifests 
itself in laughing, crying or deglutitory spasms and, if the 
irritation be of the severest kind, epileptic or tetanic spasms 
in addition. Now the occurrence of laughing, crying or 
deglutitory spasms could be easily understood if the molec- 
ular oscillation induced by the irritation were to travel along 
the associating tracts from the given spinal segment to the 
nuclei of the medulla oblongata. For in the medulla there 
are found the nerve nuclei which preside over the facial, 
laryngeal and pharyngeal muscles. It is not easy at first 
to understand how tetanus and epilepsy, that is, spasms con- 
sisting in movements whose direct projection is not in the 
medullfr oblongata but in the cord, can be produced by irri- 
tation of the former. 

There are scattered groups of nerve cells in the medulla 
oblongata which have either no demonstrable connection 
with the nerve nuclei or are positively known to be con- 
nected with the longitudinal associating strands. These cells 
hence can safely be regarded as representing a presiding 
center over the entire spinal system. No spinal center 
exerts any influence even remotely as pronounced as that 
of the entire cord. This applies to man and other mam- 
mals. That the elaboration of the medullary centre was as 
gradual a process as that of other higher differentiations is 



jdbyGoOglC 



Encephalitic and Late Epilepsy, 171 

illustrated by the case of the frog whose medulla has 
acquired the faculty of reproducing general spasms while the 
spinal cord itself retains this property also; hence here the 
predominance of the medulla is not so marked as in mam- 
mals. 

The reticular ganglion of the oblongata is not in the 
adult a part of the centra! tubular gray matter but has, 
through originally developing from it in the embryo, become 
ultimately isolated from its mother bed. It constitutes a 
second ganglionic category and the association fibers bring- 
ing it in functional union with the spinal gray (first cate- 
gory) in lower animals and shown to have assumed the 
position of projection fibers in the higher to constitute a 
second projection tract; both together are a second projec- 
tion system. The scattered gray matter of the medulla has 
an (inferentially) great importance. Anatomically it is 
(though its cells be scattered diffusely as a rule) a large 
ganglion with numerous multipolar cells of all sizes many 
of them of gigantic size sometimes exceeding the so-called 
motor cells (which they simulate in shape) of the lumbar 
enlargement in size. Scattered in the "reticular substance" 
of the medulla from the upper end of the fourth ventricle 
to the pyramidal decussation they merit the collective des- 
ignation of reticular ganglia. 

The cells of the reticular formation are known to be 
connected with the nerve nuclei on the one hand, and with 
' longitudinal fasciculi which since they run into cord, term- 
inate either in the gray matter (or the nerve roots directly) 
for nerve fibers do not terminate with, as it were, blind 
ends. Now in the mammalian brain the reticular ganglion 
lies scattered among fibres which come from the higher 
centers and the interpellation might be made whether after 
all, the reticular ganglion be not a mere intercalar station 
for fibres derived from a higher source. That originally the 
ganglion was an independent station there can be no reas- 
onable doubt for in reptiles this body of cells is too con- 
siderable to account for a termination in them of the few 
cerebral fibers possessed by these animals. And on the 
other hand the vertical strands are notably increased in 



jdbyGoOglC 



172 Jas. G. Kieman. 

their passage through the field of the medulla oblongata. 
The medulla oblongata with its reticular ganglion seems 
to be the great rhythmical center. In fish, the movements 
of the operculum and mouth, in sharks those of the spir- 
acuium; in perenni-branchiate, amphibians the branchial 
tree, in the infant the suctorial muscles, in all vertebrates 
the movements of deglutition, of the heart and respiratory 
muscles, all movements presenting 'a more or less regular 
rhythm, are under the control of the medulla oblongata. 
The early differentiation of the part of the cerebro-spinal 
axis is without doubt related to the early manifestations of 
rhythmical movements in the embryo and their predominant 
importance in lower animals. The possibility should not be 
excluded that a rhythmic movement may be spinal, nay 
even controlled by peripheral ganglia (heart of embryo), 
A higher development however implies the concentration of 
rhythmic enervations at some point where that anatomical 
association may be effected, which is the expression of the 
mutual influence these movements exercise among them- 
selves. 

Two sets of phenomena need be borne in mind in 
studying, the physiological pathology of the epileptic attack. 
First, the condition of the epileptic in the interval. Second, 
the explosion itself. Too much attention is paid to the 
last, too little attention to the first. The constitutional 
epileptic is characterized by a general deficiency of tonus, 
associated with exaggerated reaction and irritability. Thus 
the pupils are at once widely dilated and unusually mobile. 
The muscular system though generally relaxed manifests 
exaggerated reflex excitability. The mental state is char- 
acterized at once by great indifference and undue Irasci- 
bility. In the same way the vascular system is depressed 
in tone in the interval with rapid marked changes under 
excitation. The state of the nervous system as a whole 
Spitzka forcibly compares to that of an elastic band which 
being on the stretch continually, is apt to overshoot its 
mark when one end is let go. Under normal circumstances 
the band is less stretched and hence not as liable. to fly so 
far wh2n the check is removed. 



jdbyGoOglC 



Bncephalitic and Late Epilepsy. 173 

An irritation which, in health, produces restlessness of 
the muscular system, accelerated respiration and pulsation, 
and various mental phenomena within the. normal limits, in 
the epileptic results in more intense phenomena in the same 
direction. The nervous irritability of the epileptic manifests 
itself in one direction especially. An important vaso-motor 
center for the brain vessels exists possibly diffused through 
an area somewhere between the thalamus and subthalamic 
region above and the pyramidal decussation below. The 
irritability of this center results in the sudden arterial spasm 
in the carotid distribution (so characteristic a feature of the 
fit onset) ; simultaneously with the contraction of the ves- 
sel, the pupil undergoes an initial contraction, and relaxa- 
tion instantly results in both cases. The sudden interference 
with the brain circulation produces unconsciousness, and 
destroys the checking influence of the higher centers on the 
reflexes in a manner analogous to any shock affecting the 
nerve centres. In the meantime while there has been a 
sudden deprivation of arterial blood and a sinking of intra- 
cranial pressure so far as the great cerebral masses are con- 
cerned there has been as sudden an influx of blood to the 
unaffected district of the vertebral arteries whose irrigation 
territory is now the seat of an arterial hyperaemia. The 
result of this is that the great convulsion centre the medulla 
being overnourlshed, functional excess, that is, convulsion^ 
occurs unchecked by the cerebral hemispheres which are 
disabled by their nutritive shock. The unconsciousness and 
coma of epilepsy more resemble shock than they do cere- 
bral anaemia or syncope. The impeded return circulation 
of venous blood now comes into play. The contraction of 
the neck muscles explains this obstruction and the accumu- 
lation of venous blood in the cerebral capillaries of the 
medulla especially. Meynert's opinion, that this venous 
blood by the formation of cyanide-like substance acts as a 
toxic agent and produces the severer symptoms noted dur- 
ing the post convulsive period, has been recently supported 
by the finding of convulsant urine toxins by Fere, 

In addition to those sustaining the "rubber band" 
analogy the following facts tend to demonstrate the view 



jdbyGoOglC 



174 Jas. G. Kieman. 

just expressed. First (a) the contraction of the retinal 
artery (b) the initial and very brief contraction of the 
ordinarily dilated pupils; (c) the sudden pallor of the coun- 
tenance. Second (a) the secondary expansion of the retinal 
arteries; (b) the secondary dilation of the pupils; (c) the 
secondary flushing of the face. Third the post-mortem 
appearances found in those dying immediately after severe 
convulsive seizures. 

True epilepsy presents an enormous number of sub 
groups, exhibiting every variety of deviation from the ideal 
convulsive form, and the existence of these forms tends to 
demonstrate the views just expressed. In ordinary petit- 
mal the initial arterial spasm has but to be confined to the 
surface of the hemispheres leaving the thalamus ganglia un- 
disturbed and it can readily be understood how the momen- 
tary unconsciousness or abolition of cortical function can 
occur without the patient falling, his automatic ganglia still 
carrying on their functions. At the same time with the 
lesser spasm there would be a less extensive sinking of 
intracranial pressure and less consecutive collateral hyper- 
aemia of the lower centres and therefore no convulsion. 

As Meynert has suggested, in certain cases the arterial 
spasm may fail to affect the entire cortical surface simul- 
taneously, some one trunk may be more pervious and as 
afflux of blood may occur in its special field where certain 
impressions and motor innervations are stored; the result 
will then be that the function of the relatively well nourished 
territory wilt be exalted. If it be a visual perception terri- 
tory, sights, colors or luminous spectra will be seen, if it be 
an olfactory territory, odors will be smelt, if a tectile center, 
crawling, tingling and cold sensation, if a speech center, 
cries, phrases and songs maybe observed. This explains 
the manifold epileptic aura which is simply an isolated exag- 
gerated limited cortical function. The recurrence of the aura 
is readily explicable on the ground of the well known phy- 
siological law that any nervous process, morbid or normal, 
having run through certain paths, those paths will be the 
paths of least resistance for that process to follow in the 
future. To an extension of the same conditions are due the 



jdbyGoOglC 



Encephalitic and Late Epilepsy. 175 

peculiar convulsive equivalent and post- epileptic mental 
states. 

Encephalitic epilepsy while in many cases possibly 
Jacksonian at the outset but too often becomes an epileptic 
constitution with all the phenomena of idiopathic epilepsy 
underlaid by the pathology just enunciated. 

After the age of 25 and most frequently between 35 
and 40 in persons with no very decided neurotic heredity 
and in most of whom tines can be excluded, occurs an epi- 
lepsy which resembles in many respects the epilepsy from 
encephalitis. As a rule in these cases, which I have found 
equally divided as to sex, there has been a precedent period 
of nervous exhaustion attended by vertiginous states as its 
later development. 

These vertiginous states are often preceded or followed 
by anomalous sensory disturbances frequently compared by 
the patient to "waves." They pass into states attended 
by loss of or dazed consciousness with or without motor 
explosions. Some of these vertiginous states even when 
with consciousness are attended by localized jerkings of 
groups of muscles. 

All these phenomena are clearly due to toxins resultant 
on nerve exhaustions which produce the effect that Meynert 
long ago showed was due to them in ordinary epilepsy. 
Under normal circumstances, the toxins and ptomaines which 
are produced in the organism are eliminated by various 
channels. Some of these products are transformed in the 
alimentary canal into innocuous substances; gases are elim- 
inated by the lungs, other compounds are intercepted and 
decomposed in the liver; lastly, certain effete products are 
eliminated by the kidneys and skin. When any of these 
emunctories is interfered with in the discharge of its func- 
tions the phenomena of auto -intoxication make their appear- 
ance. This is observed in certain affections of the 
ahmentary system for example, which are attended by such 
symptoms as headache, pallor, hypochondriasis, etc. These 
manifestations which are the result of a chronic auto-intox- 
ication were not improperly attributed by the older writers 



jdbyGoOglC 



176 Jas. G. Kieman. 

to disturbance of the hepatic functions. As Schopfer* has 
lately shown the liver, by its peculiar intrinsic action due 
to the specific activity of its cellules, can diminish the toxic 
power of the alkaloids with which it is brought into contact. 
Such action is manifested not only in the case of poisons 
introduced through various channels into the organism, but 
also in the case of poisons elaborated internally within the 
organism itself in consequence of putrefactions of the prod- 
ucts due to the activity of the tissues. He hence advises 
intestinal disinfections and special alimentation so as to 
obviate or to minimize "auto-intoxication in all maladies in 
which the liver does not perform its functions normally." 
One therapic great element in preventing the recurrence which ■ 
constitutes the "epileptic habit" is hence diet. Asa rule the 
epileptic should be limited chiefly to a farinaceous diet. 
This should be varied In itself and by slight amounts of the 
more digestible meats, beef or mutton. Berries or small 
seed fruit, pine apples, bananas, parsnips and turnips should 
not be eaten and the amount of potatoes should be limited. 
Large quantities of water should be drunk. In this way the 
necessity for artificial intestinal antiseptics will be greatly 
limited. 

As Dr. J. M. Soniah remarks: "Recent biochemical 
researches by revealing the action of toxins, ptomaines, and 
leucomaines, have thrown much light on the action of a 
class of remedies which the older therapeutics called alter- 
atives which Headland however denominates catalytics. 
This class of remedies as Headland points out has the fol- 
lowing action. They act in the blood and their effect is 
permanent. Each of itself tends to work out a peculiar 
operation in the blood. The diseases in which they are used 
depend on certain morbid materials or actions in the blood. 
The result of the action of a catalytic medicine is in, some 
way to neutralize or counteract some one or more of these 
morbid processes. These medicines are all unnatural to the 
biood and must at length pass out of the system. These 
properties indicate their use in incipient sclerotic states. 



jdbyGoOglc 



Encephalilic and Late Epilepsy. 177 

The recent development of biochemistry and bacteriology 
demonstrates that organic compounds produced by bacteria 
and by metabolism are the origin of secondary pathological 
tissue change. Scleroses of all types may result from such 
action. Behind many forms of cirrhosis, renal, hepatic or 
gastric, is the ptomaine or syphilis. 

The foremost metallic alteratives are arsenic, gold and 
mercury. Gold is an old remedy but early in the seventies 
came into prominence because of its affinity for nerve tis- 
sue when used as a stain in preparation of microscopical 
sections. These remedies were found to act best in com- 
bination with chlorine, iodine and bromine while all of these 
last had an alterative action chlorine and iodine were long 
the chief favorites. Bromine widely used in neuroses 
attracted less attention as an alterative although when lirst 
discovered it was chiefly so used. Dr. Jas. S. Jewell* who 
incidentally noticed through its employment in neuroses that 
bromine seemed to have a specific action on the formation 
of connective tissue, remarks: 

"Some years ago I called attention to a class of cases 
in which there was chronic diarrhoea or a tendency toward 
looseness of the bowels, more or less gastric catarrh, sallow 
skin but clear conjunctiva, gastric uneasiness, habitual 
deficiency or absence of bile from the bowel discharges and 
clearly evident (from palpation and percussion) hepatic con- 
traction. In these cases there is actual hepatic atrophy. 
In them the persistent use of bromine internally has had 
good results. Its action is slow and it must be continued 
for months to be of permanent benefit. The bromine is 
given in distilled water ten drops of the liquid bromine to 
the ounce of water. Five drops of this solution should be 
given thrice daily to begin with. The dose should be 
incr^sed one drop daily until it is plain the stomach will 
no longer tolerate a large dose. If the stomach become 
irritable as a result of the remedy it may be desirable to 
reduce the dose to one or two drops or even cease its use 
altogether for a time, to resume when the stomach will tol- 



jdbyGoOglC 



178 Jas. G. Kieman. 

erate it again. It should be given in a considerable quan- 
tity of water as it is iikely to irritate the stomach otherwise. 
Under the use of bromine 1 have usually seen after a time 
less disturbances in the gastric zones, less diarrhoea, a 
reappearance of bile in the discharge from the bowels and 
a slow but decided improvement in the patient's general 
health. 

The alteratives are hence peculiarly suited for treat- 
ment of states due to toxins even antecedent to sclerosis. 
By destruction of the toxin through stimulus of hepatic 
action and elimination they tend to prevent its accum- 
ulation and the phenomena resultant on this. The alkaline 
bromides do not seem to exert this influence, hence in no 
small degree their untoward effects. Of late, metallic 
bromides have been (it is claimed) united in a compound 
the liquor arsen, auri, et hydrargyri of Barclay (arsenauro). 
This compound in the types of epilepsy to which allusion 
has been made, has given undeniably excellent results. 
Twenty drops in four doses daily are given gradually 
increased by two drops daily until slight sialorrhoea or loose- 
ness of the bowels occurs when the dose is reduced by two 
drops. None of the untoward effects of the bromides have 
beed observed and cases stupefied by them have reacted 
excellently. Like all beneficial affects of alteratives, 
improvement is at first slight but increases in geometrical 
progression. 

Of course certain symptoms require special treatment 
and an excellent adjuvant to dietetics and the alterative 
treatment is nitro- glycerin, which a little less than two 
decades ago, acting on basis of the morbid phenomena 
described, was introduced on therapeutical grounds without 
reference to bromide untoward effects. It was found by 
neurologists that it had neither the tendency to pro^juce 
mental symptoms by suppression of the epileptic discharge 
nor yet the distressing dermic phenomena. Spitzka found 
it of especial value given at shorter intervals than the 
bromides in 1-50-grain doses. Trussewitch points out that it 
should be used when there is a defect in the equilibrium 
of the vascular tone and the blood ig irregularly distributed. 



jdbyGoOglC 



Encephalitic and Late Epilepsy. 179 

It causes a rush of blood to the anaemic district or unloads 
the hyperaemic. He finds, as did Spitzka, that after a 
time there comes a toleration of the drug. It should then 
be dropped for one or two weeks when susceptibility will 
be regained. Osier finds that the physiological effects must 
be apparent before good results are obtainable. It controls, 
given on the principles indicated, the restlessness, the 
temper, as well as the motor phenomena of these epileptics. 
It is best given eight times daily in 1-250 grain doses. 



jdbyGoOglc 



PSYCHOSES OF OLD AGE. 



By Harriet c. b. Alexander, a. b., m. d., Chicago. 

Fellow of the Chicago Academy of Medicfne. 



THE psychology of normal old age, as Clouston remarks, 
has yet to be written from the purely physiological 
and brain point of view. Poets, dramatists, and novelists 
have had much to say of it from their standpoint. King 
Lear is beyond a doubt a truthful delineation of senility 
partly normal and partly abnormal. By normal senility 
Clouston means "the purely physiological abatement and 
decay in the mental function running pari passu with the 
lessening of energy in all the other functions of the organ- 
ism at the latter end of life. No doubt, in an organism 
with no special hereditary weaknesses, that had been sub- 
jected to no special strains, all functions except the repro- 
ductive should decline gradually and all together, and death 
would take place, not by disease in any proper sense, but 
through general physiological extinction. The great function 
of reproduction stands in a different position from all the 
other functions of the organism. It arises differently, it 
ceases differently and it is more affected in character accord- 
ing to the sex of the individual than any other function. 
It is, as a matter of fact, not entirely dependent on indi- 
vidual organs. It may exist as a desire and an instinct 
without sexual organs. It is probably an evolution 
from hunger. It is really an essential all -pervading 
quality of the whole organism, and to some extent 
of every individual organ, not one of which has entirely lost 
the primordial ftssiparous tendency to multiply. But the 
[180] 



jdbyGoogle 



Psychoses of Old Age . 181 

physiological period of the climacteric lias determined and 
ended it in its intensity and greater power, though many 
of its adjuncts remain; and in the male sex we have to 
reckon with it and its abnormal transformations to some 
extent even in the senile period of life. 

,, Physiological senility typically means no reproductive 
power, greatly lessened affective faculty, diminished power 
of attention and memory, diminished desire and power to 
energize mentally and bodily, lowered imagination and enthu- 
siasm, lessened adaptability to change, greater slowness of 
mental action, slower and less vigorous speech as well as 
ideation, impaired muscularity and co-ordination, a changed 
tone of voice, fewer blood -corpuscles red and white, less- 
ened power of nutrition in all the tissues, a tendency to 
disease of the arteries, a lessening in bulk of the whole 
body, but notably of the brain, which alters structurally and 
chemically in its most essential elements, the cellular action 
and the nerve currents being slower, and there being more 
resistance along the conducting fibres." 

Dr. F. P. Norbury*. like Clouston, finds that the psy- 
chological study of old age is rendered difficult by the blend- 
ing of the normal and abnormal mental states. That it is 
easy to confound ordinary functional derangements with 
organic brain disease in its earlier manifestations, we are 
ofttimes forcibly reminded. This difficulty of diagnosis and 
classification must be experienced to be appreciated. He 
has been struck by the heterogeneous symptoms yet simi- 
larity of mental affections when modified by the influence 
of senility, in a study of 196 cases of insanity occurring in 
men of over 60 years of age. Senility seems to be more 
or less, a common mould in which the mental disorders of 
age are cast, for the mark of senile change is on them all. 
It is because of the modifying influence of senility that con- 
fusion arises as to differentiation. While it is true, senile 
dementia is the only characteristic alienation of mind which 
in its uncomplicated form, conforms more to a distinctive 
type than any one form of insanity at any age, yet other 



jdbyGoOglC 



182 Harriet C. B. Alexander. 

types occur in the aged as much entitled to consideration 
both pathologically and symptomatolbgically as senile 
dementia. 

Clironic cerebral atrophy, often classed as senile 
dementia, is the most prominent type to be considered. It 
is seldom, if ever, given in hospital reports as a forni of 
senile insanity having a distinct pathology and recognized 
symptoms. In fact it is most always classed as senile 
dementia. Chronic cerebral atrophy is not necessarily con- 
fined to what is ordinarily termed the senile period, for it 
has been observed before the age of thirty. It is however 
most frequently found beyond the age of fifty. The symp- 
toms are those of despondency with suicidal tendencies, 
maniacal outbreaks, inhibited intellection, transient paralytic 
affections of speech, of monoplegia, of vertigo, etc. These 
symptoms are not unlilte those often encountered in paretic 
dementia or cerebral syphilis, but are distinguished from 
them by other associated symptoms especially of cardiac 
and renal origin. Vertigo is quite noticeable and is prob- 
ably due as Hirt says, "to the atheromatous condition of 
the arterial walls and the consequent irregularities of the 
blood supply to the brain substance. 

The melancholia is often a prominent symptom depend- 
ent alone on these circulatory changes. All have noticed in 
attacks of acute melancholia of the aged, where cardiac dis- 
ease was conspicuous, the dependence of mentality upon the 
stability and regularity of the heart's action. A series of 
such cases studied during past years has more than satis- 
fied Dr. Norbury of the dependence of melancholia on cir- 
culatory changes due to impoverished or inhibited circulation. 

The maniacal attacks of chronic cerebral atrophy with 
their explosiveness, incoherence and destructiveness may be 
of cardiac origin. Dr. Norbury repeatedly noticed especially 
in cases complicated with angina pectoris that the mania 
was very severe and distressing. The fear of impending 
death, to be noticed in individuals not insane, is in the 
insane, transposed into hallucinations and delusions destined 
to create sad havoc as demonstrated in the mental distur- 
bance of the individual. 



jdbyGoOglC 



Psychoses of Old Age. 183 

In the ordinary senile dementia, destructiveness, filthi- 
ness and incoherence occur; the physical and mental help- 
lessness being the outgrowth of the progressiveness of the 
disease. The decline is gradual ; the slowness of the 
atrophic process, producing mental symptoms is at first 
regarded as the natural result of old age. The amnesia, the 
sudden changes of moods and emotions, and the appearance 
of delusions being the evolution of distinct senile dementia. 
The persistent wakefulness at night and the tendency to 
wander away from home are trying- to home friends, and 
lead to commitment of the patient to the hospital. Here in 
his career of helplessness he lingers along until death finally 
closes the scene. 

*ReEis is. of the opinion that the insanity of old age, or 
senile insanity, is that which occurs from advance of years. 
It recognizes for its main predisposing cause heredity espec- 
ially cerebral heredity; and as its principal exciting causes, 
alcoholism, syphilis, great excesses, and misfortunes. Furst- 
ner, who has made a special study of the psychic disorder 
of old age classes them in three groups: (1) simple psy- 
choses; (2) senile psychoses with simple dementia; (3) senile 
psychoses with cerebral dementia. 

The simple senile psychoses are those in which the 
insanity is not accompanied by intellectual enfeeblement. 
It is then a more or less acute attack of mania, melancholia, 
or confusional insanity. The maniacal and confusional forms 
much the least frequent, are essentially curable. The mel- 
ancholic often due to a homologous and homochronous he- 
redity assumes by preference the anxious type, and almost 
invariably terminates in the chronic form. The senile psy- 
choses with simple dementia are those in which the insan- 
ity is associated with a condition of mental weakness without 
corresponding somatic lesions. It is a combination of an 
attack of mania or melancholia with simple dementia. It 
is generally met with as a sub-acute melancholia with ideas 
of persecution. These last are necessarily absurd and 
puerile from the co-existing dementia. The patients almost 

■Bannliter's TrunsUiDan. 



,db,Googlc 



184 Harriet C. B. AUxander. 

always think that some one has a dt^sign against them, but 
especially that they are to be robbed; this is their ruling 
idea. Under the influence of this fear they rise in the night 
hide everything they have in places which later they them- 
selves are unabie to find, they barricade themselves in their 
homes and in their rooms, and go so far, so to speak, auto- 
matically, as to accumulate in their night vessels, their 
sheets, blankets and garments. 

There may be also hallucinations of sight or hearing, 
but confused and rudimentary as they always are in 
demented conditions. There is very little or no sleep; noc- 
turnal noisiness and excitement are nearly constant in these 
patients. Their actions bear the stamp of dementia. They 
are: absurd and infantile thefts, like those of paretic 
dementia but even more foolish; sudden and causeless fits 
of passion, ridiculous and heedless attempts at suicide; also 
libidinous actions, obscene exhibitions in public, attempts 
at rape, unnatural crimes, all resulting from lack of con- 
sciousness and absolute loss of the feeling of modesty. 

The senile psychoses with cerebral dementia are those 
in which the insanity is associated, not with simple mental 
enfeeblement but with the bodily and mental symptoms of 
loss of power due to a more or less diffuse lesion of the 
nerve centres, i. e., what is called organic or apoplectic 
dementia. 

In my own experience, aside from the other psychoses 
occurring in the old, the phenomena of senile insanity prop- 
erly so-called are of peculiar interest to the family physi- 
cian. Its miserliness, wandering tendencies, suspicional 
delusions and morbid tendencies to unfit marriages, consti- 
tute a symptom-complex, at once interesting and puzzling 
to the practitioner who is called on to advise an afflicted 
family. 

The question of senility is, like so many other ques- 
tions, a relative one. One patient is senile at sixty. 
Another reaches ninety without the appearance of senile 
change intellectually. Senile insanity usually begins with 
marked loss of memory respecting very recent events while 
events of the remote past are remembered with great min- 



jdbyGoOglC 



Psychoses of Old Age. 185 

uteness and are predominant. The patient is usually irrit- 
able in temper. If the mental change proceed no further 
the patient cannot be called insane. Later on however the 
emotional and motor faculties are affected. The patients 
are often greatly but sillily exalted in ideas, given to talk- 
ativeness and stupid jokes. Both sexes are often at this 
stage very erotic. The marriage of old gentlemen to dis- 
reputable women or vice versa, has often had its origin in 
this peculiarity. The patient shows a great tendency to 
wander about. An old patient may get up at midnight to 
search for the dead lovers of her youth. As Anstie has 
pointed out, there is often a phase of mental change in the 
aged which is inexpressibly trying to the patient, and still 
more to all brought into contact with him. It consists in a 
peculiar perversity, a tendency to offer vexatious and friv- 
olous delay and opposition to everything which is suggested 
by others, however important the occasion. They are just 
that sort of folk who insist on making perverse and unreas- 
onable alterations in wills when these have been settled 
long before in a just and convenient manner or who quar- 
rel in their last days upon some frivolous pretext with the 
friend of a life time. 

The first indication in treatment is to meet the waste 
which underlies the restlessness of senile insanity as it 
does the restlessness of mental conditions due to other 
exhaustional states. Frequent feeding at regular intervals 
of two hours per diem often exercises a decidedly beneficial 
effect on the restlessness and querulency. Sometimes milk 
and eggs will quiet when sedatives fail. Conium, sulphonal 
and cannabis indica act best as sedatives. The patient's tend- 
ency to in.somnia of an intermittent type often yields to a 
warm mixture of milk and eggs followed in a couple of 
hours by conium and cannabis indica or sulphonal. In some 
cases salix nigra and camphor monobromate act excellently. 

Prognosis as regards perfect recovery, is bad. The 
erethism may quiet down and the patient lead a relatively 
happy life in the insane hospital but such a seemingly 
recovered patient, "such a nice old lady," often renders 
home a perfect torment by unreasonable demands. Often 



jdbyGoOglC 



186 Harriet C. B. Alexander. 

this is due to the lack of regular feeding and sometimes to 
the patients relations from whom he will take less direction 
than from strangers. The delusions of being impoverished 
often aids insane hospital treatment. The patient who 
believes she is in a poor house takes food frequently because 
it costs her family nothing. 

As to frequency three per cent, of the patients admit- 
ted to the Cook County insane hospital were so demon- 
strably senile lunatics as to require hospital treatment. A 
larger percentage went to the poor house. For proper treat- 
ment at home, the ensurement of regular rest, frequent 
feeding and careful watchfulness against wandering tend- 
encies are absolutely requisite. If these cannot be secured 
the patient should be sent to an insane hospital. One such 
case will often wear out an entire family. 

The results of senile insanity in families have not 
escaped, as Clouston remarks, the attention of dramatists 
and novelists. A most interesting description of insanity in 
the senile period appears in "King Lear." 

Brigham* (one of the ablest American alienists) half a 
century ago, regarded Lear as a genuine case of insanity 
correctly reported. Still he apprehends that the plan or 
cause is generally misunderstood. The general belief is that 
the insanity of Lear originated solely from the ill treatment 
of his daughters while in truth he was insane before that 
from the beginning of the play when he gave his kingdom 
away and banished as it were Cordelia and Kent and abused 
his servants. The ill-usage of his daughters only aggravated 
his disease and drove him to raving madness. Had it been 
otherwise, the case as one of insanity would have been 
inconsistent and very unusual. Shakespeare and Walter 
Scott prepare those whom they represent to be insane by 
education and other circumstances of the disease. They 
predispose them for insanity and thus its outbreak is nat- 
ural. In the case of Lear insanity is so evident before he 
received any abuse from his daughters that professionally 
speaking a feeling of regret arises that he was not so con- 

•Amtric^m Jnynal gf Imilnil, Vol. W. 



jdbyGOOglC 



Psychoses of Old Age. 187 

sidered and so treated. He was unquestionably very trouble- 
some and by his "new pranks, "as his daughter calls them, 
caused his children much trouble and introduced much dis- 
cord into their household. In fact a little feeling of com- 
miseration for his daughters at first arises in our mind from 
these circumstances though, to be sure, they furnish no 
excuse for their subsequent bad conduct. Let it be remem- 
bered they exhibited no marked disposition to ill-treat or 
neglect him until after the conduct of himself and his 
knights had become outrageous. Then they at first reproved 
him or rather asked him to change his course in mild man- 
ner. Thus Goneril says: 

Whereol I know you are trauehl. and pu( away 
Th*s« disposlllons. whkh ol tale (ranslorm you 
From whal you ar«." 

showing that previously he had been different. This how- 
ever caused an unnatural and violent outburst of rage but 
did not originate his insanity for he had already exhibited 
symptoms of it and it would have progressed naturally even 
if he had not been thus addressed. Lear is not after this 
represented as being constantly deranged. Like most per- 
sons affected by this kind of insanity he converses ration- 
ally. In the storm scene he became violently enraged 
exhibiting what may be seen daily in an insane hospital, 
a paroxysm of rage and violence. It is not until he has 
seen and conversed with Edgar, the philosopher and learned 
Theban, as he calls him, that he became a real maniac. 
After this aided by a proper course of treatment he falls 
asleep and sleep as in all similar cases partially restores 
him. But the violence of his disease and his sufferings are 
too great for his feeble system and he dies and dies 
deranged. The whole case is instructive not as an inter- 
esting story merely, but as a faithful history of a case of 
senile insanity. 

Bucknill* very lucidly points out about the period of 
improvement that: This is not mania but neither is it 
sound mind. It is the emotional excitability often seen in 

■Mad Folk of Shakiipearc. 



jdbyGoOglC 



188 Harriet C. B. Alexander. 

extreme age as it is depicted in the earlier scenes of the 
drama, and it is precisely true to the probabilities of the 
mind's history that this should be tiie phase of infirmity 
displaying itself at this moment. Any other dramatist than 
Shal<espeare would have represented the poor king quite 
restored to the balance and control of his faculties. The 
complete efficiency of filial love would have been made to 
triumph over the laws of mental function. But Shal<espeare 
has represented the exact degree of improvement which was 
probable under the circumstances namely, restoration from the 
intellectual mania which resulted from the combined influ- 
ence of mental and physical shock, with persistence of the 
emotional excitement and disturbance which is incur- 
able and unalterable because of the malign influence of old age. 
Dr. Isaac Ray leans to the opinion that Lear is intend- 
ed to represent insanity in senescence rather than senile 
insanity. In Lear, Ray* remarks, Shakespeare has repre- 
sented the principal character as driven to madness by the 
unexpected ingratitude of his daughters; or more scien- 
tifically speaking, he has represented a strong predisposi- 
tion to the disease as being rapidly developed under the 
application of an adequate exciting cause. It is no part of 
his object to excite curiosity by a libera! display of wild- 
ness and fury nor to awaken our pity by the spectacle of 
a mind in ruins, and unconscious of its wretchedness. He 
aimed at dramatic effects by opening the fountain of sym- 
pathy for a being of noble nature and generous impulses 
cruelly despoiled of the highest endowment of man, but not 
so far as to lose all traces of his original qualities or cease 
for a moment to command our deepest respect. In Lear, 
we have a man of a hot and hasty temper, of strong and 
generous passions, of a credulous and confiding disposition, 
governed by impulses rather than deliberate judgement, 
rendered impatient of restraint or contradiction by the habit 
of command with a nervous temperament strongly suscept- 
ible to the vexations of life and, moreover, with all these 
moral infirmities aggravated by old age. With tliese simple 



jdbyGoOglc 



Psychoses of Old Age. 189 

elements of character is mingled and assimilated more or 
less of mental derangement, with equal regard to patholog- 
ical propriety and dramatic effects. And so nicely adjusted 
are the various elements of sanity and insanity and so 
admirably do they support and illustrate one another that 
we are not surprised in the progress of the action by vio- 
lent contrast; and we feel at last as if it were the most 
natural thing in the world that Lear should go mad, and 
precisely in the way represented by the poet. Mad as he 
becomes, the prominent attributes of his character are 
always to be seen. Through the whole play, he is the 
same generous, confiding, noble-hearted Lear. In short, 
assuming Lear to be an historical portrait instead of a 
poetical creation, we should say there existed in his case a 
strong predisposition to insanity, and that if it had not been 
developed by the approach of old age, or the conduct of his 
daughters, it probably would have been by something else. 
His inconsiderate rashness in distributing his kingdom 
among his children, his disinheriting the youngest for the 
fearless expression of her feelings and his banishment of 
Kent for endeavoring to recall him to a sense of his folly, 
all indicate an ill-balanced mind if not the actual invasion 
of disease. This view of the case is confirmed by the con- 
versation between the sisters immediately after the division 
of the kingdom. Goneril says: 

hath ever tul slendtrly knovm himself. " 

"The best and soundest of his time," continues Gon- 
eril, "hath been but rash, then must we look to receive 
from his age not alone the imperfection of long engrafted 
condition but there withal the unruly waywardness the 
infirm and choleric years bring with them." Kegan then 
adds. "Such inconstant starts are we like to have from 
him as this of Kent's banishment," With a knowledge of 
insanity that could hardly have been expected from any but 
a professional observer, Shakespeare has here and elsewhere 
recognized the fact that very many of those who become 
insane are previously distinguished by some of those mental 



jdbyGoOglC 



190 Harriet C. B. Alexander. 

irregularities that pass under the name of oddity or eccen- 
tricity. 

The next thing we hear of Lear is his beating one of 
Goneril's gentlemen. His remarks on learning the fact 
show that his mental condition has not been improving 
since his abdication and prepare us for the mournful sequel. 



His knlehis erow riotous, and hloiHlf upbraids us, 

The development of the early stage of Lear's insanity, or 
its incubation as it is technically called, is managed with 
masterly skill, the more surprising as it is that stage of the 
disease which attracts the least attention. And the reason 
is that the derangement is evinced not so much by delusions 
or gross improprieties of conduct, as by a mere exaggera- 
tion of natural peculiarities, by inconsistencies of behavior, 
by certain acts for which very plausible reasons are 
assigned though they would never have been performed in 
a perfectly sound state of mind by gusts of passion at 
every trifling provocation or by doing proper things at 
unreasonable times and occasions. With his own free will 
and accord he gives away his kingdom but finds it difficult 
to sink the monarch in the private citizen. He attaches to 
his person a band of riotous retainers whose loose and law- 
less behavior proves destructive to the peace and good order 
of his daughter's household. Goneril describes them as: 



Under such an infliction it is not strange that she should 
remonstrate and had not the divine light already begun to 
flicker he would ■ have acknowledged the justice of the 
reproof. As it is, however, instead of admitting some share 
of the fault, he attributes the whole of it to her, flies into 
a passion, pours upon her head the bitterest curses, upbraids 
her with the vilest ingratitude and forthwith proclaims his 
wrongs to the public ear. Like most cases in real life it 
would have to a stranger, the appearance of a family quar- 



jdbyGoOglC 



Psychoses of Old Age. 191 

rel springing from the ordinary motives of interest or pas- 
sion, but where really the ill-regulated conduct resulting 
from the first influence of disease provokes restrictions more 
or less necessary and appropriate, that become exciting 
causes of farther disorder. Another life-like touch is given 
to the picture, in Lear's attributing all his troubles to filial 
ingratitude, not being aware of course that he was on the 
high road to insanity long before he had any reason to 
doubt their kindness. In fact nothing is more common than 
for the patient when telling his story, to fix upon some 
event and especially some act of his friends, as the cause , 
of his troubles, which occurred long subsequently to the 
real origin of his disorder, and might have had but an 
accidental connection with it. The conduct of his daughters 
faithfully exhibits strong tendencies of human nature. No 
doubt their patience was severely tried — such a trial as only 
the mildest temper joined with the firmest principle could 
enable them to stand successfully. Wanting these how- 
ever, his irregularities are met with reproaches and stric- 
tions instead of kind and conciliating measures, an explosion 
follows and in mutual hate and anger they separate. To 
their heartless natures such conduct may not have appeared 
like umnitigated ingratitude toward a father who had loved 
and cherished them as the very idols of his heart, but to be 
founded on provocation that seemed to justify their 
behavior. Such is the ingratitude of the world ever coupled 
with some shallow pretense of wrong or indignity sustained 
and often presenting the fair outside show of a worthier 
feeling in the daughter's treatment of her father. Shake- 
speare strips off the thin disguise of conventional morality 
and lays bare that heartless selfishness which is ever ready 
to sacrifice to momentary ease and gratification the tender- 
est sympathy of our nature. It is fearful to think how 
often the case of Lear and his daughters is paralleled in 
actual life and it is the very commonness of the fact that 
prevents us from regarding it as a curious monstrosity, fitted 
to excite but a momentary horror, and which imparts a 
deep moral interest to the representation of the poet. 

When the astounding fact of Goneril's baseness is fin- 



jdbyGoOglC 



192 Harriet C. B. Alexander. 

ally made so plain to Lear that he can no longer doubt, 
his senses appear to reel under the shock, and for a mom- 
ent he questions his own identity. "Does any here know 
me? Why this is not Lear! Does Lear walk thus, speak 
thus? Where are his eyes? Either his notion weakens or 
his discernings are lethargied. Sleeping or waking? Ha, sure 
'tis not so. Who is it that can tell me who I am?" 

The continued objurgations of Goneril and her bare- 
faced impudence in proposing a diminution of his train soon 
produced a reaction in his mind and Lear gives vent to his 
feelings in that blasting curse whose bitterest ingredient 
was the wish that she might feet: 

Then bursting into tears of which his noble nature is 
ashamed he quits the presence of a child upon whose 
affection he had reckoned for the support of his declining 
years, and resolves to go to his other daughter who had 
shared his bounties, certain that he would receive from her 
the hearty welcome and tender regards that he had been 
scornfully refused by her sister. While pondering upon past 
scenes he is conscious that his mind has sustained a fear- 
ful shock and as is often the case in such circumstances 
he has a vague presentment of the fatal result. 

■O. W me not he maJ. not maJ, sw*e1 HMvenI 
Keepmelnlcmper: 1 wouiJ not be maai" 

On arriving at Regan's residence he finds that she refuses 
to see him, and that his faithful follower has been placed 
in the stocks. These things excite his suspicion that all is 
not right and renew the agitation that had been moment- 
arily quieted. Still he is slow to believe what is evident 
enough to everybody else and fondly hugs the delusion in 
which his only hope of happiness rests. But when the 
conviction is forced upon him that Kegan even goes beyond 
her sister in ingratitude, he utters a wail of heartful 
wretchedness and lofty indignation, ending with another 
foreboding of the impending calamity. "O fool, I shall go 
mad." Driven with contumely and scorn from that shelter 
in the affections of his child which he had fondly expected 
to find,' he goes forth at night and braves the pelting of the 



jdbyGoogle 



Psychoses of Old Age. ■ 193 

pitiless storm. The howling of the wind, the roar of 
thunder and the flash of lightning are welcome, for at least 
they lack the sting of filial ingratitude and are in mournful 
accordance with the tumult in his own crushed and bleed- 
ing bosom. One dark overshadowing, all engrossing idea, 
the cruelty of his daughters is suggested by every object, 
gives a tone to all his reflections and like the worm that 
never dies, is gnawing perpetually at his heart. Well might 
he invoke the fury of the element upon his head for the 
worst they could do would be mercy compared with the 
torments his own flesh and blood had inflicted. 



There is now obviously a degree of incoherence and absurdity 
in the thoughts that race through his mind though they are 
never destitute of that grandeur and boldness of expression 
indicative of his lofty and noble nature. But the idea of the 
thunder cracking nature's moulds and destroying the germs 
of the. race contained in his invocation to the elements, is 
a little too fanciful for even a figure of poetry. In a simi- 
lar strain he charges the elements with conspiring with his 
daughters against his old white head, and soon after imag- 
ines that the Gods have raised the storm for the purpose 
of finding out their enemies. This is crazy enough no 
doubt; but his apostrophe to sinners of various kinds that 
immediately follows, is both correctly and beautifully 
expressed. He seems to be fully aware that his thoughts 
are deviating from the right track and exclaims that his 
"wits begin to turn." The predominant idea follows him 
in the next scene, and ever and anon intrudes upon his 
reflections though he always recoils from it with a kind of 
horror, as if conscious it had the power to deprive him of 
his reason. "O that way madness lies." Unable as the 
insane are to perceive their own insanity yet this appre- 
hension of its approach so frequently repeated by Lear 
usually occurs during incubation. While still able to con- 
trol his mental manifestations the patient is tortured with 
anticipations of insanity; but when he actually becomes so 
insane that the most careless observer perceives the fact. 



jdbyGoOglC 



194 Harriet C. B. Alexander. 

he entertains the most complacent opinion of his intellectual 
vigor and soundness. And yet this is one of the nicer 
traits of insanity which the ordinary observer would hardly 
be supposed to notice. But Shakespeare was no ordinary 
observer; and this explains the cause of his preeminence 
in certain parts of his art. 

The appearance of Edgar who is feigning madness in 
order to avoid his enemies, again excites Lear's predomin- 
ant idea and fixes it permanently in his mind. The form- 
er's ragged, wretched, degraded condition, he can attribute 
to nothing but filial ingratitude and he pours out curses on 
Edgar's unnatural daughters. He is no longer able to cor- 
rect the errors of his own judgement; reason exercises but 
a feeble control over his conclusions and scarcely a gleam 
of light struggles through the darltness which envelopes his 
soul. The predominant idea however has not yet relin- 
quished its hold and it stilt gives direction to his thoughts. 
The very images of his daughters appear before him in vis- 
ible forms glowering upon him with looks of scorn and hate. 
The idea of placing them on trial enters his mind and he 
proceeds to the business with all due forms and solemnities. 
Edgar the fool, and Kent are appointed to the bench, his 
daughters in the shape of joint tools are arraigned before 
the court; and Lear appears as witness against them. 
Then, after a brief interval, during which it would seem as 
if lie imagined them to have been convicted and sentenced, 
he exclaims with touching pathos; 

The scene on the hearth between Lear, Edgar and the 
fool, has not its like, in the whole range of dramatic liter- 
ature. No less a genius than Shakespeare would have 
ventured to bring together face to face three such difficult 
characters, one actually mad, one falsely pretending to be 
so and the third a fool. And yet in the successful manage- 
ment of such discordant and intractable materials, he has 
given a fresh instance of his wonderful skill. Nothing could 
have seemed more likely to disappoint and displease than 
to bring the noble-hearted Lear, staggering under the shock 



jdbyGoOglC 



Psychoses of Old Age. 195 

of his daughter's ingratitude with blasted heart, bewildered 
reason, into such strange companionship, and yet who can 
finish this scene without feeling that he has read a new 
chapter in the history of mental disease of most solemn and 
startling import. The sight of another in rags and wretch- 
edness reveals to Lear a deeper depth of agony in his own 
soul. He sees in the stranger only another victim of filial 
ingratitude, the counterpart of his own case, and Edgar's 
weak and blighted condition forewarns him of his own 
approaching fate. Its first effects is to produce a shower of 
curses on Edgar's unnatural daughters and the next to draw 
him toward his fellow sufferer by that kind of sympathy 
which, irrespective of social conditions, is awakened by 
mutual affliction. In this play of wild and discordant fancies, 
the fool mingles his humors which fall on the ear like 
sounds of jollity and mirth ascending from a house of 
mourning. The successful management of such deep masses 
of. light and shade whether in poetry or painting requires 
the master hand of Shakespeare or a Rembrandt. 

Thus far the progress of Lear's insanity is represented 
with the closest tidelity to nature. It is not more different 
from the disease as daily observed, than Lear's normal and 
intellectual constitution, when in health, is different from 
that of ordinary men. At every interview reason seems to 
have lost somewhat of its control. The mental excitement 
has been steadily increasing until now having reached its 
height, he goes about singing, dancing and capering through 
the field, fantastically decorated with weeds and flowers 
looking, acting and talking like a madman. His perceptive 
organs are deceived by hallucinations and his discourse 
though tinctured with his natural shrewdness and vigor 
of thought is full of incoherence and incongruity. In short 
he is now what is called raving. In the representation of 
his condition we have another instance of Shakespeare's 
unrivalled powers of observation. To ordinary apprehension 
the raving of a maniac is but an arbitrary jumble of words 
and phases between which no connecting threads can be 
discerned. But in fact discordant and heterogeneous as they 
may appear, they are nevertheless subjected to a certain 



jdbyGoOglC 



1% Harriet C. B. Alexander. 

law of association difficult as it may be frequently to dis- 
cover it. The phenomenon may thus be physiologically 
explained. In consequence of the cerebral excitement, 
impressions long since made, so long perhaps as to have 
been forgotten previous to the attack are so vividly and 
distinctly recalled that they appear to be outward qualities. 
So long as the intellect retains its integrity it is able to 
recognize the true nature of the phenomenon; but when 
touched by disease it ceases to correct the error of percep- 
tion. The impressions are actually considered to be what 
they appear and the patient thinks and discourses about 
them as such. In his mind's eye he sees sights and in his 
mind's ear he hears sounds, imperceptible to others and 
this is the source of much of our difficulty in discovering 
the object and relevancy of his remarks. 

Another source of our difficulty in discovering the filia- 
tion of the maniac's thoughts has been generally overlooked 
and the fact strongly shows with how little sagacity the 
operations of the insane mind have been studied. The 
maniac being restrained by no sense of the propriety or 
fitness of things, expresses every thought that enters his 
mind or, at any rate, is governed by no principle of selec- 
tion. In the sound mind on the contrary a considerable 
portion of the thoughts never find utterance in words, being 
suppressed from their want of the connection with one 
another, or their irrelevancy to the subject in hand. Every 
one must be aware how often in the course of ordinary con- 
versation, thouEhts start up having the remotest possible 
connection with anything already said. So remote indeed, 
as to defy any one but himself to discover it. Any person 
who should utter every thought that arose in his mind in 
the freest possible conversation would most certainly be 
taken for a fool or a maniac. The mental defect is far from 
being confined to the state of raving. In a greater or less 
degree it occurs in almost every form of insanity. Even 
those whose delusions are very circumscribed, who conduct 
for the most part with great propriety and to common 
observers betray no indication of unsoundness in their 
conversation, will usually evince it when very talkative and 



jdbyGoOglC 



Psychoses of Old Age. 197 

encouraged to talk without interruption. Their remarks may 
be correct and even slirewd, not a single word may l?e 
uttered "sounding to folly" while there is a certain 
peculiarity in the association of their ideas never witnessed 
in the sound mind. Though not easily described it is read- 
ily recognized by those who are conversant with the insane 
and to them it is a conclusive proof of mental disease, 
though they may be incapable of making the grounds of 
their conclusion intelligible to others. Courts and juries are 
not always disposed to make sufficient allowance for the 
fact and regard with suspicion the embarrassment of the 
medical jurist, who sees that what is to him the strongest 
proof of insanity is to others no proof at all. Bearing in 
mind these facts we readily see how there may always be 
some method in madness, however wild and furious it may 
be, some traces of the delicate thread which, though broken 
in numerous points, still forms the connecting link between 
■ many groups and patches of thoirght. It is in consequence 
of Shakespeare's knowledge of this psychological law that 
in all his representations of madness even though character- 
ized by wildness and irregularity, we are never at a loss to 
perceive that the disease is real and not assumed. Not so 
however with most writers even of distinguished name who 
have undertaken to represent the workings of a diseased 
mind. Unaware of the law in question and governed by 
the popular notions on the subject they seem to have aimed 
only atlunlimited extravagance and incoherence. Otway, for 
instance, in "Venice Preserved" represents Belvidera in that 
state of menial disturbance which results from wounds of 
the softer affection of the heart. A speech full of those 
strong and vehement expressions characteristic of deep felt 
emotion but presenting no trace of delusion finishes with 
the following jargon, which no insane persons would have 
uttered in such a connection, though it might very likely 
proceed from one simulating the disease. 

In the first scene in which Lear makes appearance after 
becoming stark mad, his mind is solely occupied with images 



jdbyGoOglC 



198 Harriet C. B. Alexander. 

formed under the influence of tlie intense excitement of the 
internal perceptive organs. He at first fancies liimself in a 
battle and then as engaged in the sports of archery and 
falconry. Something reminds him of Gonerit and then suc- 
ceeds to one another by a natural association, the ideas of 
a white beard, of the flattery of his courtiers of the detec- 
tion of their deception. When Gloster hears his voice and 
asks if it be not the liing's, Lear replies, "Aye, every inch 
a king." Visions of his royal state then pass before his 
eyes and he is reminded of the criminals he pardoned and 
the crimes they committed, and tlience, by a natural trans- 
ition he is led to some caustic reflection on the frailties of 
women. Another remark of Gloster turns his mind to the 
examples of self righteousness and self deception, servility 
and time-serving with which the world abounds and in a 
strain of bold indignant sarcasm lie lashes the vice to which 
poor human nature is especially prone. All this is exceed- 
ingly natural. It is not uncommon to meet with madmen, 
of the most wild and turbulent description mixing up their 
utterances with the shrewdest remarks upon men and 
things, and the keenest and coolest invective against those 
who have incurred their displeasure. The poet perhaps has 
used the utmost license of his art in the present instance, 
but if few madmen have exhibited sn much matter mingled 
with their impertinency as Lear it may be replied in ju.sti- 
lication that few men are endowed like Lear with such a 
union of strong passions and natural shrewdness of under 
standing. 

Here endeth the madness of Lear. By his youngest 
daughter he is placed in the charge of a physician whose 
medicines throw him into a deep skep from which and his 
madness together he awakes as from a dream. The man- 
ner of his recovery displays the poet's consummate skill 
that could delineate the most touching and beautiful traits 
while observing the strictest regard to facts. Lear at first 
knows not where he is nor where he has been. He scarcely 
recognizes his own friends and almost doubts his own 
identity: 



jdbyGoOglc 



Psychoses of Old Age, 



Whii p1>» (his Is: ind all ih* skill t havt 
Where I did lodice list nieht." 

A faint idea of recent events now occurs to him and he 
says to Cordelia: 

"Your lincri 

A more faithful picture of the mind at the moment when it 
has emerged from the darkness of disease into the clear 
atmosphere of health restored was never executed than this 
of Lear's recovery. Generally recovery from acute mania is 
gradual, one delusion after another giving way until after a 
series of struggles which may occupy weeks or months, 
between the convictions of reason and the suggestion of 
disease the patient comes out a sound, rational man. In a 
small proportion of cases however this change takes place 
very rapidly. Within the space of a few hours or a day 
he recognizes his true condition, abandons his delusions, and 
contemplates all his relations in an entirely different light. 
The management of Edgar's simulation strikingly evinces 
the accuracy and extent of Shakespeare's knowledge of 
mental pathology. In placing the real and the simulated 
affection side by side he has shown a confidence in his own 
skill which the result has perfectly justified. In no other 
way could the fidelity of his delineations have been sub- 
jected to so severe an ordeal. We are left in no doubt as 
to the views of what is and what is not genuine insanity, 
and by holding before us an elaborate picture of each, he 
enables us to compare them together and to judge of his 
success for ourselves. In these pictures he has availed 
himself of no equivocal traits; the touches of his pencil are 
of that strong and decided character that admits but a 
single meaning. Not more true to nature is the represen- 
tation of Lear writiiing under the stroke of real insanity 
than is that of Edgar playing upon tlie popular curiosity 
with such shams and artifices as would most effectually 



jdbyGoOglC 



200 Harriet C. B. Alexander. 

answer the simulator's purpose. The one is an exhibition 
of character as genuine and marked by as distinctive traits 
as the other; and Shakespeare would have been as unlikely 
to confound them and mistake the one for the other as to 
fail to recognize the commonest forms of nature around him. 

Edgar's first design is to personate a Tom O'Bedlam 
beggar, one of a class of lunatics who were discharged from 
Bethlehem Hospital when restored in some measure, that 
they might subsist upon the charity of the community. 
Accordingly he provides himself with their usual dress and 
appurtenances, repeats their phrases and imitates their 
practices for exciting the compassion of the charitable. 
In his anxiety to produce an impression, he falls into the 
common mistake of simulators who overact their part and 
thus betray their true character to the practiced observer. 
We could not commit a greater error than to regard this 
fact as a fault of the poet who displays in it a power of 
philosophical discrimination which, when strongly marked, 
is indicative of the highest order of genius. The subject 
of the past is to deceive multitudes, not the professional 
student, and for this purpose nothing could be better calcu- 
lated than the gibberish which he utters in his double 
character of a lunatic beggar and a victim of demoniac 
possession. Had it been Shakespeare's design to represent 
a case of real demonomania or of chronic mania, we should 
unquestionably have had something very different from the 
part of Edgar. If the former, we should not have found 
the patient talking so clearly about his own case, while 
indulging in unlimited incoherence and rambling about 
everything else; and, if the latter, we should not have 
seen a strain of acute moralizing succeeded more than once 
by a trait of mental imbecillity. Poetically considered, the 
feigned madness of Edgar is well calculated by force of 
contrast to deepen the impression made by real madness 
of Lear. The abject condition of the former excites our 
pity as an object of physical distress which we would 
endeavor to relieve, in the case of Lear, however, all the 
finer emotions of the soul are aroused by the sight of a noble 



jdbyGoOglC 



Psychoses of Old Age. 201 

nature, crushed to the earth by sufferings which touch the 
inmost springs of humanity. 

We cannot dismiss this play without a passing notice of 
the fool in whose character Shakespeare has shown that 
his observation of mental impairment was not confined to 
one of a few of its forms. He is used like the same char- 
acter in other plays, his quips and cranks serving as a 
foil to the humor of his stronger minded companions. They 
who. find fault with the poet for infusing too much wisdom 
into the folly of his fools may well take a lesson from him 
in certain branches of psychological study. In the present 
instance, he knew what is not generally known even 
now, as we often have painful reason to remark that 
a very obvious degree of intellectual deficiency is sometimes 
accompanied by a little shrewdness of observation and 
practical sagacity. They, who are much conversant with 
this form of mental impairment, have no difficulty in believ- 
ing that the very person who is unable to rise to the sim- 
plest abstract truth may occasionally utter a shrewd remark 
and succeed as well as wiser men in "shooting folly as it 
flies." It was this class of subjects that furnished the 
domestic fools and court jesters of the olden times. With 
no sufficient understanding or character to awaken the jeal- 
ousy of their patrons or exercise any restraint upon their 
manners they had the sense to discern the foibles and fol- 
lies of their superiors and ready wit enough to extract from 
.them food for amusement and mirth. The biting jest and 
timely reproof were good-naturedly received since their 
acknowledged imbecility rendered them for the most part, 
quite irresponsible for their sayings and doings. With such 
characters royalty could unbend without loss of dignity and 
enjoy a jest even at its own expense- 
Dickens in "Old Curiosity Shop" has depicted an 
even more pathetic instance of a senile lunatic, more 
demented than King Lear who displays the wandering tend- 
ency of old age and its suspicional delusions. These serve 
as a beautiful foil to the devotion of "Little Nell." 

From a forensic standpoint, unjust wills, false accusa- 



jdbyGoOglC 



202 Harriet C. B. Alexander. 

tions of cruelty against children and relatives, indecent 
exposure, criminal assaults especially on children of both 
sexes, illegal and improper marriages and other contracts, 
and theft are to be expected from senile lunatics. 



jdbyGoOglc 



THE AUTO -TOXIC ORIGIN OF 
EPILEPSY.* 



By J. NELSON TEETER, M. D., 

ASSISTANT PHYSICIAN UTICA STATE HOSPITAL. 

WE do not see epilepsy at birth, and not for years 
afterward may it show itself. It is the predispo- 
sition wliich is transmitted, and not then until some excit- 
ing cause presents itself to act upon the susceptible nerve 
cells do we have the manifestation of faulty inhibition, 
development, nutrition or whatever the condition may be. 
The child of epileptic parentage may have an attack of 
intestinal trouble (perhaps putrefactive, therefore toxic) fol- 
lowed by a convulsion. The nervous centers have shown 
themselves susceptible to the intestinal irritant and it is 
reasonable to suppose that upon a subsequent and similar 
irritation another convulsion will occur. The predisposition, 
which might be called the epileptic habit, becomes con- 
firmed when the inhibiting influence governing the action of 
nerve cells is lost, this inhibiting influence being paralyzed 
by the intoxicating agent, Gowers says: "Epilepsy is a 
disease because the tendency to what we call 'discharge' 
is increased each time the tendency has its effect." Thus 
the epileptic habit is established. 

J. S, Bristowe reports cases of epileptiform convulsions 
apparently produced by extreme slowness of the pulse. In 
his cases the pulse during the intervals between the attacks 
was as slow as 20 to 30 beats per minute, and after the 
attacks reached 70 to 120 beats to the minute. It would 
seem to me that in these cases the extreme slowness of 



jdbyGoOglc 



204 J. Nelson Teeter. 

the heart, with the consequent retarded circulation in the 
veins and lymphatics, ahowed the accumulation of toxic 
principles in the brain, giving rise to an irritation which 
resulted in convulsive manifestations. Dr. T. Oliver, in 
reporting a case of "Epilepsy in a Puerpera with Hyper- 
pyrexia," speaks of the imperfect renal action allowing the 
retention of animal poisons in the blood, "there being no 
reason why the disordered blood of pregnancy, with its 
altered arterial tension and plethora should not so influence 
the cerebral centers as to lead to the nervous explosion 
upon which the fit depends," In this patient no convul- 
sions occurred until pregnancy was established, and the 
author excluded kidney disease or any reflex difficulty. 

It has been shown in extended observations by Herter 
and Smith that intestinal putrefactive processes are dis* 
tinctly related to the epileptic paroxysm. They have 
demonstrated that intestinal putrefaction is indicated by the 
amount of sulphuric acid in ethereal combination found in 
the urine. The degree of intestinal putrefaction appeared 
to influence the seizures in part of the cases cited, being 
less during the intervals and increasing up to and after the 
attacks. Haig .claims a relation between uric acid and 
epilepsy, namely, that grand mal is caused by an excess of 
uric acid in the blood, while there is a decrease in the 
amount found in the urine before, and an excess at the 
time of the paroxysm. 

It thus appears that the subject of auto- intoxication in 
epilepsy as a factor in its etiology has occupied the minds 
of many acute observers and is the path in which we 
should direct our work until the subject is at least exhaus- 
ted. The excretory products found in the urine and faeces 
have received most attention and been tlioroughty investi- 
gated, except the substances found in tlie urine by Bouch- 
ard and which he designates "extractive matters," one of 
which upon injection into animals produces convulsions, 
another lowers the temperature, and, lastly, one contracts 
the pupil. To quote from Bouchard: "One kilogramme of 
man eliminating in twenty-four hours a quantity of urine 
capable of killing 461 grammes of animal, the proportional 



jdbyGoOglC 



The Auto-Toxic Origin of Epilepsy. 205 

part of the mineral matter in this toxicity may be indicated 
as follows; potass, kills 217 grammes; soda, 30 grammes; 
calcium, 10 grammes; magnesia, 7 grammes. The whole 
of the mineral matter kills 264 grammes. On the other 
side, urea kills 63 grammes. There remains to be destroyed 
134 grammes." 

"We may say that one kilogramme of man eliminates 
in 24 hours organic matter, capable of being fixed by char- 
coal, which is able to destroy at least 134 grammes of ani- 
mal. These substances (coloring, extractives or alkaloids) 
represent 30 per cent, of the total toxicity. It is to these 
■ substances, still undetermined, that hereafter the effort of 
chemistry should be directed." 

The writer has formulated the following schedule of 
work directed toward the solution of the problem of auto- 
intoxication in epilepsy, which will, as far as possible, be 
carried out in our laboratory: 
I. Urine. ( Intervals. 

II. Blood. J Before paroxysm. 

Cerebro-spinat fluid. ( Alter paroxysm. 
Inorganic principles. 
Toxicity as shown by injecting animals. 

Organic principles. { ^^aclil'e matters of Bouchard. 

On account of the many changes to which the urine is 
subjected after expulsion from the body, it occurred to him 
that an examination of the blood itself would present a 
more direct and definite evidence of toxic principles existing 
in the body. This is the work at present being carried 
out, and this report will be confined to the amount of urea 
found in the blood serum. 

Considerable difficulty was experienced in ascertaining 
a go«d method by which the urea could be separated from 
the blood, but the following description of Haycraft's method 
from the works of Professor Gamgee appears the most 
simple. Twenty c, c. of blood is defibrinated and placed 
upon a parchment paper dialyzer and spread over it so as 
to form a thin layer. Float in a vessel containing 50 c. c. 
of absolute alcohol. From time to time add a very little 



'{":. 



,db,Google 



206 /. Nelson Teeter. 

distilled water to keep the mass on the dialyzer moist — 
continue the process for twelve hours. 

Treat the diffusate with an equal bulk of concentrated 
solution of oxalic acid and evaporate to dryness. To the 
residue add some petroleum naphtha to remove fatty matters. 
Dissolve the residue in a little water and add barium car- 
bonate. Evaporate. Treat the residue with boiling alcohol 
and filter. Concentrate the filtrate, from which, on cooling, 
urea will crystallize out. The advantage of this method is 
that the urea is obtained pure and can be subjected to test. 
The amount of urea in healthy blood has been variously 
estimated at from 25 to J5 milligrammes per 100 grammes ■ 
of blood. 

The small superficial veins of the forearm slioiild be 
selected, as, in case obliteration of the vein occurs subse- 
quent to the operation, collateral circulation is readily estab* 
. lished. A bandage should be tied tightly above the elbow, 
as in the ordinary process of bleeding, and after the arm 
has been m:ide thoroughly clean witii soap and water fol- 
lowed by carbolic acid, alcohol and ether, a >miill incision 
is made over the distended vein and parallel to it. When 
the superficial fascia is exposed, the skin should be drawn 
to one side so that it is possible to cut along side the vein 
rather than directly over it. If the vein is not completely 
bared, the hemorrhage will diffuse beneath the fascia and 
by pressure cause the flow of blood to cease. A smalt cut 
is made in the exposed vein and the fme stream of blood is 
allowed to flow into a glass graduated in cubic centimetres 
held by an assistant. I have found it better to take 40 
c. c. of blood as the specific gravity can be more readily 
secured. When the quantity of blood desired is obtained, 
the bandage should be removed at once and n compress 
dressing applied to the wound. I have experienced no 
unpleasant after effects from successive bleedings. This 
should be attended to by an assistant, as the blood requires 
immediate attention. After defibrination, which may be 
done with a glass or wire brush, the specific gravity should 
be taken. It is then placed upon the dialyzer and the 
process continued as before mentioned. Care should be 



jdbyGoOglC 



The Auto-Toxic Origin of Epilepsy. 207 

taken to have the parchment fit very tightly to the glass 
so as to prevent the possibility of the alcohol leaking 
directly into the dialyzer, which event would render the 
operation worthless, as no osmosis would occur. The urea, 
being a crystalloid, separates from the mass on the dialyzer 
and is taken up by the alcohol which, when treated by the 
oxalic acid, results in the oxalate of urea. The barium car- 
bonate combines with the oxalate of urea, forming the 
oxalate of barium, separating carbonic acid and urea. After 
the final filtration and concentration the liquid is left to 
cool and urea crystallizes out in rhombic prisms, which may 
readily be seen under the microscope. 

Case no. l. — Male, age 54, single, farmer. Admitted 
September 12, 1895, suffering from a maniacal condition 
following several epileptic attacks. His history shows that 
he had been suffering from grand mal since twelve years 
of age, the attacks occurring about once a month, and that 
now he is a confirmed epileptic. Only one examination of 
the blood could be obtained as patient refused to allow 
further bleeding. 

Case no. II.— Male, age 30, single, book-keeper. 
Admitted December 9, 1892, also suffering from a maniacal 
condition superimposed upon epilepsy. He had suffered from 
attacks occurring about once a month of the grand mal 
form since childhood. Only three examinations were obtained 
in this case. 

Case no. hi.— Male, age 37, single, waiter. Admitted 
August 17, 1893. He has suffered from grand mai for six- 
teen years, and occasionally from psychical attacks. Since 
admission to the hospital his attacks have continued with 
undiminished severity. Four examinations of the blood 
were procured in this case. 

Case no. IV. — Male, age 32, single, no occupation 
Admitted June 4, 1895, with a diagnosis of epileptic 
dementia. He has suffered since childhood with attacks o 
the grand mal form which occurred about twice a week 
Since admission the attacks have continued with the usua 
severity and frequency. Eight examinations were made in 
this case. 

For one month previous to the commencement of the 
blood examination all treatment was stopped and the 
patient allowed the routine hospital diet. In cases ill. and 
IV. all the urine was collected and examined for the tota( 



jdbyGoOglC 



208 



J. Nelson Teeter. 



amount of urea excreted by the kidneys in twenty-four 
hours, and attention paid to the variation in the amount 
before and after convulsions, A convalescent patient was 
used as a "control" case in the blood examinations. In 
the following table is a record of the quantity of blood 
drawn, its specific gravity, the amount of urea found, and 
the relation of the examination to an epileptic paroxysm is 
given : 

BLOOD EXAMINATION. 



D.t 


1 
1 
. ] C.W. 

i 
24 1 
9 II 

1?, " 
16, ■' 
Z. Ill 

3 :: 

1 
17 •■ 
24 IV 

30; " 

2' •• 

71 ■' 

13 '■ 
20 " 
16 '■ 
12' " 
12, Contro 


M 


1 
Tlm« or tam- 


41 

J_ 
03 
005 
021 
032 
02 
015 

01 
015 
032 
02 

118 

.01 

.012 
.02 
.02 
.021 

.005 
.003 


- 8i| 


June 
July 




.072 

.01165 

.098 

.0755 

.094 

.0345 

.024 
.0709 




20 21.12 1056 
40 42.32 1058 






fen minutes alter tit.i 




40 ,42.16,1054 
40 42.1611054 

1 
20 21.12 1056 




Aug. 


Three fits from 6:30 to' 

7:30; blood alter 1st | 

Just alter fit. [fit.^ 




20 21.121056 
40 '42.24,1056 

20 21.081054 

40 42.241056 
40 .42.00 1050 
20 '21.2011060 
40 42.161054 

1 1 
20 ■21.12^1056 
20 2C. 90 1045 






July 

AUE. 

Stpt 
June 


Fli, 11 P. M., blood, 
11:10 P. M 

Fit. 9 A. M., blood, 4; 

Just after fit. 
Just after fit. ' 
Ten minutes after lit. 
Six hours after fii.| 


2654 

.046 
.028 
.047 
.0942 
.0497 


Aug. 





.0143 



In case No. 1 the amount of urea obtained in the single 
examination exceeded the normal of .025 to .035 grammes 
per 100 grammes of blood — averaging about double this 
estimate. There was no convulsion in proximity to the 
examination. In case No. II. the first examination presented 
a decrease from the normal; the second a considerable 
increase, being .098 grammes per 100 grammes of blood. 
There was no convulsion before these examinations. The 



jdbyGoOglC 



The Auto-Toxic Origin of Epilepsy. 209 

thkd examination was made ten minutes after an attack of 
grand mal, presenting an increase above the nornral to 
.0755 grammes. This is lower than tlie result obtained on 
July 13th, but it may be noted tliat the fit followed three 
days later. It will be seen in the examination of July 7th 
of case IV,, that the amount of urea found apparently 
decreases the longer the interval up to a limited point 
between the fit and the examination. We find in this case 
an average for the three examinations of .0617 grammes 
per 100 grammes of blood, or, in other words, about twice 
the amount of urea found in normal blood. 

Passing on to case No. Ill: On July 1st patient had a 
number of severe epileptic attacks of the grand mal form. 
The examination of the blood on the day following showed 
.094 percentage of urea. No convulsions occurred before the 
examination of the 7th, and the percentage of urea fell to 
.0345 grammes. On the 9th patient had three fits and the 
blood drawn between the attacks showed in this instance 
only the normal average, the percentage being .024 gram- 
mes. On the 17th the blood taken directly after the fit 
showed .0709 grammes of urea per 100 grammes of blond. 
The average amount of urea found in 100 grammes of blood 
for the four examinations we therefore find to be .055 
grammes, which will be seen to exceed the normal. 

In case No. IV., the first examination gave a result of 
less than normal, the second a considerable increase, and 
the third, which was performed ten minutes after the con- 
vulsion occurred, reached the remarkable average of .2654 
grammes in percentage amount. These three examinations 
showed a continued increase up to and just following an 
epileptic paroxysm. The next examination, made five days 
later, and seven hours after a convulsion, showed .046 
grammes of urea, a marked decrease over the previous 
result. An examination on the 13th, and after a fit, showed 
a still further decrease, when the amount again began to 
rise, and on August 16th reached ,0942 grammes in per- 
centage amount following a fit. In this case it will readily 
be seen how greatly the amount of urea varies and how 
inconstant are the results as compared with the epileptic 



jdbyGoOglC 



210 J. Nelson Teeter. 

paroxysm. In the control case it will be noted that the 
urea .held to or was below the normal average. 

The average amount of urea passed by the urine in 
case No. 111. during the months of July and August was 
9.45 grammes per 24 hours; less than one-third the normal 
amount. An increase in the amount of urea per cubic cen- 
timetre before the convulsions occurred was noted and cor- 
roborated the results recorded in the writer's previous paper 
spoken of in the first part of this article. In case IV. the 
average amount of urea excreted by the kidneys was 11.64 
grammes per 24 hours — about one-third the normal amount 
of 33.19 grammes. A similar increase in amount of urea 
per cubic centimetre before the fit occurred was noted in 
this case. 

Conclusions: As before quoted, Bouchard states that of 
the 461 grammes of animal killed by the amount of urine 
excreted by one kilogramme of man in 24 hburs, urea killed 
only 63 grammes, from which we must infer that urea rep- 
resents only a small part of the total toxicity of the urine. 
My results, though meagre, would seem to corroborate this 
view, for the variability of the amounts of urea found, even 
when examinations were made under apparently similar 
physical conditions, would seem to prevent the possibility of 
placing much importance upon this excretory product as a 
cause of epileptic convulsions. I do not mean to eliminate 
it entirely from the list of toxic causes, for it is probable 
that auto-intoxication is not due to any one toxic principle 
alone, but to the action of a combination of all the poisons. 

We can only conclude that, firstly, there is an average 
increase in the anrount of urea found in the blood serum 
of cases of idiopathic epilepsy above that of normal man; 
secondly, there seems to be but little relation between the 
amount of urea found and the epileptic paroxysm, as in 
some cases we find an increase directly after a fit, in oth- 
ers a diminution. The increase of urea found in the urine 
after a convulsion must be accounted for in other ways, 
possibly by the great muscular exertion during the fit, or 
by the diuretic action of the urea itself as it accumulates 
in the blood. This would seem to be proven by the blood 



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The Auto-Toxic Origin of Epilepsy. 211 

examination, as the amount of urea found was seen to 
gradually decrease for some time after the epileptic par- 
oxysm occurred. Probably a more fruitful field of research 
in this direction will be an examination of the toxicity of 
the blood serum before, after, and during the intervals of 
epileptic convulsions, as shown by injection into the lower 
animals. 

BtBLIOGRAPHY. 
Ch. Bouchard: "Lectures on Auto- Intoxication In Disease," 1894. 
Herter and Smith: ">Etlologyol Idiopathic Epilepsy," N. Y. MedicalJounial, 

'92. pp. 208, 234 and 260. 
W.R. Cowers: "The Dynamics of Life In Relation to the Nature ol Epilepsy." 

Tht Unctl. 1S94. pp. 1015 and 1080. 
Victor Horsley: "The Origin and Seat of Epileptic Disturbance," Brilisf, 

MtdicalJoumal, 1892. pp. 693 and 696. 
T. Oliver: "Epilepsy In a' Puerpera with Hyperpyrexia," Tkt Lanett, Vol. 

1, p. 1295. 1894. 
Rub«rt Boyce: "The Seat of Origin and Paths ol Conduction of the Fits In 

Absinthe Epilepsy," Brilish Medical Joumat, 1893, pp. 1097. 
E.T.Wynne: "The Morbid Anatomy of Epilepsy," Tht LanctI, 1893, p. 433. 
J. S. Bristowe: "The Influence ol Extreme Slowness of Pulse In the Caus- 
ation of Eplieptlfonu Convulsions." Tht Laitcti, 1894, pp. 671. 
Charles Mercier: "The Origin and Seat ol Epileptic Disturbances," British 

Mtdieal Jounial, 1892, pp. 809. 
A Halg: "Uric Add as a Factor In Causation of Disease." 
J. N. Teeter: "On the Relation of Urea to Epilepsy," Amtricatt Journal of 
Insanity, January, 1895. 



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SELECTIONS. 



NEUROTHERAPY. 

EFFECT OF THE X-RAY ON THE CENTRAL NER- 
VOUS SYSTEM. — Some interestinfi experiments are reported 
from Russia {S/. Petenb. Med. IVocli., No. 1, 1897), that 
tend to sliow that the X-ray has a quieting effect on tlie 
central nervous system. A frog was placed in a small 
wooden box on wliich the ray was directed, while the con* 
trol frog, in a similar box, was protected from the ray by a 
sheet of lead laid on top of the box. It even counteracted 
the effects of strychnine, as no traces of intoxication were 
noticed in the frog after the aJministration of 0.04 milli- 
grams, and exposure to the ray, while the control frog was 
found in tetanic convulsions. Half an hour's exposure 
before administering the strychnine rendered it possible to 
increase the dose, without intoxication. — Journal American 
Mediciil Assoc ill I ion. 

THE TREATMENT OF ATONY OF THE SMALL INTES- 
TINE IN NEURASTHENICS.— Dr. Chalmet Uoiiinal des Prat- 
iciens) , believing that whether the nervous system presiding 
over the epithelial (secretion and absorption) and muscular 
functions may or may not play the principal part in this 
condition, the best method of improving the tone of the 
nerve is to nourish it better. To improve nutrition he 
administers during (he early hours of intestinal digestion, a 
salt water enema of a concentration above that of blood 
serum — e. g. ; 1-2 per cent, of salt — in order that he may 
produce in the large intestine an osmotic current which shall 
act at a distance upon the small intestine, retarding absorp- 
[212] 



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Selections. 213 

tion and permitting the transformation of food-stuffs to go 
on for a longer period before absorption of the liquor con- 
taining these substances in solution. — Modem Medicine, 

CONSCIOUSNESS IN EPILEPSY.— The following are the 
conclusions of a paper by Prof. E. Siemerling on "The 
Transitory Disturbances of Consciousness in Epileptics in 
tlieir Forensic Relations," Berliner Klin U^ochenschr., Nos. 
42 and 43, 1895: 

1. In the epileptic psychoses a dream-like, altered 
condition of consciousness is probable, and not by any 
means a total or partial amnesia. 

2. The most various transition forms occur between 
the different forms of so-called acute and chronic epileptic 
psychoses. Epileptic or epileptoid conditions and psychoses 
must alike be reckoned as symptoms of cerebral disease. 

3. The transitory, dreamy states are characterized by 
the rapidly recurring, apparently orderly, indifferent, and 
inconspicuous manifestations, and by unusual, unexpected, 
often, violent acts. 

4. There is no epileptic psychosis without epileptic or 
epileptoid antecedents. Epileptoid conditions are more fre- 
quent than is commonly supposed, especially vertiginous 
attacks. 

5. With the lack of epileptic or epileptoid manifesta- 
tions, all other symptoms, such as amnesia, similarity of 
tlie attacks, peculiarities of actions, sensory hallucinations, 
will serve to make the diagnosis of epilepsy most probable. 
— Canada Lancet. 

INTESTINAL ANTISEPTICS IN INSANITY.— The use of 
drugs intended to prevent or check fermentation and pu- 
trefactive changes in the intestinal tract has found extensive 
application in the treatment of acute insanity. Our usual 
procedure is to give a laxative or free purge, then some 
one or a combination of several intestinal antiseptics — B. 
napthol, napthalin, boric acid, bismuth, carbolic acid, calo- 
mel, thymol and chlorine solution (yeo). Many cases of 
melancholia in particular are benefitted. In epilepsy the 
use of B. napthol especially has been attended by good 



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214 Selections. 

results in improvement in general health and dimunition in 
number of convulsions. — Bryce Hospital Report. 

NEUROPATHIC HEART— C. H. Brockway, M. D., of 
Worcester, Mass., has found Cactina Fillets useful in func- 
tional disorders of the heart. 

INJECTIONS OF OSMIC ACID FOR NEURALGIA.— Dr. 
Erwin Franck (Fortschrilte der Medicin) reviews the literature 
from 1882 and recommends osmic acid, 1 ; distilled water, 
6; glycerin, 4; (Schapiro) to be kept in a closed bottle. 
Of this one-sixth of a grain of the drug is used, although 
ill one instance the dose was four times this amount. 
Three cases are reported — right facial neuralgia, sciatica, 
and tabes in ataxic stage. In the first, cure resulted; in 
the second, disappearance of the pain for eight weeks, 
recurrence, which the treatment failed to relieve; in the 
third, relief of the hyperesthesia and neuralgia of the ulnar 
nerve, cessation of the pain during time of observation (one 
month). The needle is inserted perpendicularly and deep 
into the muscles or to the bone as near as possible to the 
most painful point, the overflow on the skin being prevented 
by a bit of cotton. When injections are made into the 
face, a smaller quantity should be used to avoid induration, 
which may be of a dark color. 

Saline subcutaneous Transfusion in the 

Insane. — Ur. James T. Searcy, superintendent and phy- 
sician -in -chief of the Bryce Insane Hospital at Tuscaloosa, 
Alabama, gives the following record of his work in this 
direction : 

In some cases of acute mental disease, cases showing 
auto -infection symptoms, and in cases refusing food, excel- 
lent results have followed the employment by hypodermic 
transfusion of large quantities (one litre) of 75 per cent. 
blood-warm sterilized solution of sodium chloride. The 
injection is made into the loose areolar tissue of the 
abdominal wall or gluteal region. The improvement in cir- 
culatory activity and arterial tone, increase in urinary 
secretion, relief of dryness of lips and tongue, clearing of 
mental faculties, etc., are often quite pronounced, and perma- 



jdbyGoOglC 



Selections. 215 

nent improvement is sometimes obtained. The injections have 
not been used oftener than once daily; are sometimes used 
from one to three times only — sometimes continued for 
weeks. To the simple saline solution other salts may be 
addedi as magnesium sulphate for its laxative effect, or the 
fluid may be made nutritive by addition of egg albumin. 
The introduction of the needle and fluid is only slightly 
painful, and under antiseptic precautions no ill result will 
follow. This treatment has been used in about thirty 
cases. 

THERAPEUTIC VALUE OF MERCURY AND ARSENIC— 
Probably, says The Times and Register, no practitioner is 
doubtful as to the therapeutic value of mercury and arsenic. 
Probably every physician has encountered grave difficulty in 
administering these agents for a sufficient length of time or 
in proper quantities to produce their full therapeutic effect. 
Before their remedial properties have had opportunity to 
exert themselves some form of stomachic disturbance or an 
exhausting diarrhoea accompanied by profound mental depres- 
sion,- have indicated their discontinuance for sufficient time 
to permit the patient to re-establish such tone as would 
enable him to again "stand the treatmeat." This is espe- 
cially true in its application to mercury, and equally true, 
though in a lesser degree, with reference to arsenic. That 
these metals have been rendered more easy of assimilation 
and their therapeutic value distinctly enhanced by skillful 
manipulation and combination, recent medical literature 
leaves little doubt. 

In the preparation known as Arsenauro we have in 
solution a combination of the bromides of arsenic and gold, 
which is certainly an advance in pharmacy. 

Mercauro, which is one of the same class, has in addi- 
tion to gold and arsenic the bromide of mercury in solution. 

According to Drs. Stucky, Lydston, Wight, Dumesnil, 
Ingersoll, Wade, Kennedy and others, these solutions are 
blood- builders and blood-makers, valuable nerve tonics and 
vaso-motor stimulants, and in the experience of several. 



jdbyGoOglC 



Mercauro has earned first place in the treatment of the 
later stages of syphilis, with its accompanying nerve tissue 
degeneration. 

A CASE OF CEREBRO-SPINAL MENINGITIS COMPLI-. 
GATING GONORRHOEA TREATED BY ANTIKAMNIA.— The 
concluding remarks from the above article, by G. S, Leggatt, 
M.R.C.S., England, L.S.A., tal<en from the Lancet (London) 
are interesting from both therapeutic and physiological stand- 
points. 

Remarks. I. "This is a rare complication of gonorrhoea, 
and, as far as I can fmd, is not mentioned in any of the 
books which refer to the subject; but bearing in mind the 
similitude of structure between the meninges and the joints 
there seems no reason why they should not be occasionally 
attacked in a manner similar to the latter. 

2. "Antikamnia is a remedy said to possess analgesic, 
antipyretic and anodyne properties. Its dose is three to 
ten grains, and it will be observed that the doses I gave 
were large ones; but the symptoms were extremi^ly urgent, 
and it is interesting to note that there was no depression. 
During its exhibition the pulse improved in force, and the 
administration of the drug reduced the temperature to nor- 
mal, and seemed in this respect to be greatly superior to 
that of phenacetin, 

3. "As to the diagnosis it is Jililicult to know how the 
symptoms, which were of a most pronouuced kind, could be 
accounted for on any other supposition than involvement of 
the fibrous textures of the spine and cranium. That the 
disease did not more definitely and more permanently attack 
the pia mater and arachnoid is probably due to the prompt 
administration of the antikamnia and salicylate combined, 
which seemed to me to prevent the optic neuritis and other 
more obvious and serious consequences of an established 
meningitis." 

PSYCHIATRY. 

NEUROPATHIC HEREDITY AND ALCOHOLISM, AND 
VICE Versa. — Sollier, wlio wrote the recent Aubenal prize 
essay on alcoholism, commended and prefaced by Bourne- 



jdbyGoOglC 



Selections. 217 

ville, gives some clinical records which clinch the proofs 
beyond all controversy, as to both the neuropathic and the 
alcoholo-neuropathic heredity of the drink crave, the drink 
habit and the drink vice, and vice versa. 

1. Ben — 4 yrs. Congenital idiocy. Grandfather and 
great grandfatlier inebriates. 

2. Maisohn — 14 years. Epilepsy and hemiplegia. 
Father and paternal grandfather inebriates. 

3. Deloim — II years. Idiopathic epilepsy. Father and 
paternal grandfather inebriates. 

4. March — 8 years. Complete symptomatic idiocy, 
Fatlier and paternal grandfather inebriates. 

5. Dumas — 10 years. Imbecility. Hemiplegia of left 
side. Father and paternal grandfather inebriates. 

6. Assass — 6 years. Complete idiot. Father and 
paternal grandfather inebriates. Paternal grandmother hem- 
iplegic, 

7. Lefes — 21 years. Idiopathic epilepsy. Maternal 
grandmother and maternal cousin (german) inebriates, 

8. Fan — 5 years. Complete epileptic idiot. Maternal 
grandfatlier inebriate and idiot, and nephew of grandfather 
inebriate, 

9. Abbad — 10 years. Epileptic idiocy. Maternal uncle 
and grandfather inebriates. Maternal great grandfather 
nervous affections. 

10. Marni — 8 years. Cerebral atrophy and imbecility. 
Father inebriate, and paternal grandfather inebriate and 
suicide. 

11. Porcher — 6 years. Epilepsy. Father and paternal 
grandfather inebriates, 

12. Peck — 8 years. Slight idiocy. Father and pater- 
nal grandfather inebriates, 

13. Que — 7 i'ears. Complete idiocy. Father and 
paternal grandfather inebriates. 

14. Amb — 10 years. Epilepsy and mental debility. 
Father and paternal grandfather inebriates. 



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218 SeUctions. 

15. (Same Subject.) Mother and maternal grand- 
father inebriates. 

16. Dur — 7 years. Mental instability. Father and 
maternal grandfather inebriates. 

17. Dethan — 11 years. Idiocy. Father and paternal 
great-uncle inebriates, 

18. Tanp — 8 years. Slight idiocy. Father and pater- 
nal grandfather inebriates. 

19. Noisen — 19 years. Congenita) idiocy. Father and 
paternal grandfather inebriates and apoplectics. Paternal 
uncle suicide. Paternal grand-uncle, apoplectic, and pater- 
nal great-grandmother senile dementia. 

20. Ada — 14 years. Pronounced imbecility. Father 
and paternal grandfather inebriates. Paternal grandmother 
paralyzed . 

21. Berg — 16 years. Epilepsy. Father and paternal 
great-uncle inebriates. 

22. Bourarl — 14 years. Epilepsy. Father and paternal 
grandfather inebriates. 

23. Charpeut — 11 years. Idiocy and deafness. Father 
and paternal grandfather inebriates. 

24. Thierr — 12 years. Hysteria and epilepsy, homi- 
cide. Paternal grandfather inebriate. 

25. Comms — 17 years. Imbecility. Father inebriate, 
and paternal grandmother inebriate and idiot. 

26. Farg — 13 years. Cerebral atrophy and hemi - 
plegy of left side. Father and paternal grandfather ine- 
briates and venereal. 

27. Hunsick — 16 years. Epilepsy. Motlier and mater- 
nal grandmother inebriates, 

28. Laugl — 17 years. Mental instability and epilepsy. 
Father and paternal grandfather inebriates. 

29. Rioch — 13 years. Imbecility. Father's uncle and 
paternal grandfather inebriates, 

30. Rami — 16 years. Epilepsy. Father and paternal 
grandfather inebriates. 



jdbyGoOglc 



Selections. 219 

31. Co — 6 years. Epilepsy and mental debility. 
Father and paternal Rrandfather inebriates. 

32. Bourd — 13 years. Symtomatic epilepsy. Uncle 
and paternal grandfather inebriates, and paternal grand- 
mother died of an affection of the marrow. 

33. Ducr — 5 years. Mental instability. Sister and 
father inebriates, and mother insane. 

34. Poup — 8 years. Cerebral sclerosis. Father and 
paternal grandfather inebriates. 

35. Cahe — 17 years. Epileptic hysteria. Father and 
paternal grandfather inebriates. 

36. Dufa — 10 years. Idiopathic epilepsy. Father,uncle 
and paternal grandfather inebriates, and two paternal aunts 
inebriates. 

37. Stem — 10 years. Imbecility. Paternal grandfather 
and paternal great- grandmother inebriates. 

38. Hel — 18 years. Epilepsy and hemiplegia. Father 
and paternal grandfather inebriates. Paternal grandmother 
paralyzed. 

39. Parment — 16 years. Idiopathic epilepsy. Father 
and paternal grandfather inebriates. 

40. Pen — 16 years. Idiopathic epilepsy. Father and 
paternal grandfather inebriates. 

41. Quen — 9 years. Idiocy. Father and paternal 
grandfather inebriates. Paternal uncle suicide by hanging. 

42. Riedling — 14 years. Hysteria and imbecility, 
Father and paternal grandfather inebriates. 

43. Remeli — 14 years. Epilepsy and alcoholism. 
Father and paternal grandfather inebriates. 

44. Rua— 42 years. Alcoholic and epileptic. Father 
alcoholic and apoplectic, brother apoplectic, and cousin 
feeble, 

45. Thei — IQ years. Epilepsy. Father and paternal 
grandfather inebriates. 

46. Bont — 15 years. Idiopathic epilepsy. Father and 
paternal grandmother inebriates. 

47. Guid — 16 years. Epilepsia and dementia. Father 
ataxic, paternal uncle inebriate, paternal grandfather delir- 



jdbyGoOglC 



220 Selections. 

ium-tremens, and paternal great-grandfather inebriate. 

48. Chambel — 13 years. Complete idiocy. Uncle and 
maternal grandfather inebriates. 

49. Min — 7 years. Idiot. Father and paternal great- 
uncle inebriates. 

50. Cher — 59 years. Epileptic and alcoholic. Father 
and brother inebriates. 

51. Car — 34 years. Alcoholic and epileptic. Father 
alcoholic. 

52. Mor — 3 years. Epileptic idiot. Mother alcoholic 
and debauched. Maternal grandmother the same. 

53. Led — 14 years. Pronounced imbecility and epi- 
lepsy. Paternal grandfather inebriate, and two paternal 
cousins (german) epileptics and inebriates. 

54. Lefer — 27 years. Epilepsy, athetosis, and hemi- 
plegia. Father and paternal grandfather inebriates, and 
paternal cousin (german) inebriate. 

55. Coq — 16 years. Epilepsy. Father and paternal 
grandfather inebriates. 

56. Bar — 18 years. Mental debility. Father and pater- 
nal grandfather inebriates. 

57. Desant — 45 years. Inebriate and epileptic. Father 
alcoholic, debauched and paralyzed, and paternal grandfather 
paralyzed. 

58. Fourn — 10 years. Epilepsy, idiocy and hemiplegia. 
Father and paternal grandfather inebriates. 

59. Hug — 15 years. Cerebral atrophy and epilepsy. 
Father and paternal grandfather inebriates. 

60. Leqr — 16 years. Idiopathic epilepsy. Father and 
paternal grandfather inebriates. 

61. Lamruch — 18 years. Idiopathic epilepsy. Pater- 
nal great-uncle alcoholic and suicide. Paternal great-grand- 
father alcoholic and suicide. 

62. Lei — 14 years. Imbecility. Mother and maternal 
grandfather inebriates. 

63. Ney — 37 years. Idiopathic epilepsy. Father and 
paternal grandmother inebriates and cousin (german) of 
father insane. 



jdbyGoOglc 



Selections. 221 

64. Delac — S years. Idiot. Father and grandfather 
alcoholic. 

65. Coeur — 10 years. Idiot and hydrocephalus. Father 
and paternal grandfather inebriates. 

66. Leclu — 33 years. Epileptic hysteria. Father alco- 
holic, and paternal grandfather alcoholic and drowned. 

67. Doucer — 14 years. Epilepsy and infantile hemi- 
plegia. Father and paternal grandmother inebriates 

68. (Same subject) — Uncle and maternal grandfather 
inebriates. 

69. Boyan — 6 years. Epilepsy. Father, uncle and 
paternal grandfather inebriates. 

70. Fair — 9 years. Halfwitted in childhood and men- 
tal debility. Father and maternal grandfather inebriates. 

71. Pica — 16 years. Epilepsy, Brother, father, uncle 
and grandfather inebriates. Paternal grand-uncle alcoholic 
and suicide. Mother alcoholic. Maternal grandfather ine- 
briate and hung. Maternal grandmother alcoholic and para- 
lyzed. Maternal uncle and maternal great-grandmother ine- 
briates. 

72. Hub — 19 years. Epilepsy. Father and paternal 
grandfather inebriates. 

73. {Same subject) — Maternal grandmother and great- 
grandmother inebriates. 

74. Hir — 18 years. Hysteria and epilepsy. Maternal 
grandfather, and maternal great grandfather inebriates. 

75. Hani — 18 years. Epilepsy and mental debility. 
Father, uncle and paternal grandfather inebriates. 

76. Alrat — 17 years. Mental instability. Father ine- 
briate, suicide, and paternal uncle and grandmother ine- 
briates. 

77. Hall — 17 years. Epilepsy. Father, two uncles and 
paternal grandfather inebriates, sister nervous, and a grand 
aunt (on the mother's side) insane and maternal grandfather 
paralyzed. 

78. Margat — 13 years. Epilepsy. Brother and father 
inebriates, and paternal grand-uncle and grandfather the 
same. 

79. Mige — 13 years. Epilepsy and hemiplegia of left 



jdbyGoOglC 



222 Selections. 

side. Paternal cousin ((-erman) inebriate. Father, uncle 
and paternal aunt inebriates, paternal grandfather and great- 
grandmother inebriates, and paternal grandmother insane. 

80. Pius — 17 years. Cerebral atrophy and hemiplegia 
of left side. Father, uncle, and paternal grandfather ine- 
briates, hysterical aunt, melancholic great^aunt, and paternal 
grandmother nervous attacks. 

81. Pig — 11 years. Convulsions, vertigo, imbecility. 
Father and paternal grandfather inebriates, and paternal 
great-grandfather insane. 

82. Pil — 14 years. Imbecility and hydrocephalus. 
Father, grandfather, and grandmother inebriates. 

83. Sauln — 10 years. Imbecility and strabismus. 
Father, grandfather, and grandmother inebriates, great- 
grandfather and grandmother (parents of grandmother), ine- 
briates, 

84. Brouck — 16 years. Idiot and epileptic. Father, 
paternal uncle and grandfather, inebriates, and paternal 
great^aunt insane. 

85. Chas — 4 years. Deaf Idiot. Father and paternal 
grandfather and grand-uncle inebriates. 

86. Etien — II years. Inebriate. Maternal grandfather 
inebriate, and maternal great- grandmother, paralyzed. Insane 
cousin. 

87. Toff — 9 years. Imbecility and epilepsy. Father, 
paternal uncle and grandfather inebriates. 

88. Taut — 14 years. Complete idiot. Father and 
paternal grandfather inebriates. 

89. Laumail — 9 years. Imbecility and symptomatic 
epilepsy. Father and paternal grandfather inebriates. 

90. Jon — S years. Congenital idiocy. Brother, father, 
paternal grandfather, and maternal grandmother inebriates. 

91. Lepi — 12 years. Imbecility and cerebral sclerosis. 
Maternal uncle and grandfather inebriates. 

92. Clong — 3 years. Complete idiot. Mother, grand- 
father and grandmother, inebriates. Maternal great-grand- 
mother inebriate. 

93. Terr — 10 years. Imbecility and infantile paralysis. 



jdbyGoOglC 



Selections. 223 

Paternal grandfather alcoholic and apoplectic. Great grand- 
father inebriate and great grandmother apoplectic. 

94. Mong — SO years. Alcoholic and epileptic. Father 
alcoholic. 

95. Fevrier — 20 years. Imbecility. Father inebriate. 
Paternal grandmother inebriate and insane. Paternal grand- 
father paralyzed. Paternal great grandmother demented. 
Paternal uncle insane, and paternal aunt demented. 

96. Sorg — 20 years. Idiot. Father and paternal grand- 
mother inebriates. 

97. Muls — 18 years. Alcoholic and epileptic. Mother 
inebriate. 

98. Widm — 20 years. Hysteria, epilepsia. Two uncles 
and maternal grandfather inebriates. 

99. Mor — 14 years. Alcoholism, epilepste. Father 
and maternal grandfather inebriates. 

100. Songe — 24 years. Alcoholic and epileptic. Pater- 
nal grandfather alcoholic. Paternal uncle insane. Paternal 
cousin-german hysteria. 

101. Monneh — IS years. Imbecility and epilepsy. 
Mother and maternal grandfather, inebriates. Maternal 
great-aunt and grandmother suicides. 

102. Alep — 8 years. Alcoholic and epileptic. Father 
and paternal giandfather inebriates. 

103. Buie — 14 years. Idiot. Father, paternal grand- 
father and grandmother inebriates. Paternal cousin-german 
inebriate, and paternal grandfather hung. 

104. Lob — 1 year. Hydrocephalus. Father and pater- 
nal grandfather and grandmother inebriates. 

105 (Same Subject) — Maternal grandfather and great- 
grandfather inebriates. 

106. Caldair — 12 years. Epilepsy. Brother, father and 
paternal grandfather inebriates. 

107. Tot — 5S years. Epilepsy. Father inebriate, and 
paternal grandfather paralyzed. 

108. Rob — 6 years. Symptomatic idiocy. Maternal 
grandmother alcoholic and debauched. Maternal great grand 
aunt insane. Maternal great aunt drowned. 

109. Gonell — 15 years. Epilepsy and hemiplegy of 



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224 Selections. 

left side. Materna) grandfather inebriate. Maternal great- 
grandmother paralyzed. 

110. Dop — 14 years. Symptomatic epilepsy. Father 
absinthic. Paternal aunt drunkard, and paternal grand- 
mother apoplectic. 

HI. Siv — 23 years. Idiopathic epilepsy. Father alco- 
holic, dying of cerebral apoplexy. Paternal grandfather 
paralyzed. Paternal great- uncle suicide. Paternal uncle 
epileptic and insane. 

112. Bert — 3 years. Idiot. Maternal uncle inebriate. 
Maternal great^uncle spendthrift. Maternal grandfather ine- 
briate. 

113. Mehn — 17 years. Epilepsy, athetosis and hemi- 
plegy. Father alcoholic and paternal grandfather paralyzed. 

114. Masser — 6 years. Pronounced imbecility. Father 
inebriate and paternal grandfather apoplectic. 

US. Bruc — 13 years. Imbecility. Father inebriate and 
paternal grandmother senile dementia. 

116. Chaut — 6 years. Symptomatic imbecility. Pater- 
nal grandfather inebriate. Paternal great-grandfather insane. 

117. Doist — 12 years. Epilepsy. Father alcoholic and 
paternal grandfather insane. 

118. Rochet — 12 years. Imbecility. Father inebriate 
and paternal great-uncle insane. 

119. Poins — 18 years. Idiot. Maternal grandfather 
inebriate and maternal great -grandmother paralyzed. 

120. Boutr — 8 years. Epilepsy and mental debility. 
Father inebriate and paternal grandfather insane. 

121. Drug — 16 years. Idiopathic epilepsy. Father 
alcoholic. Paternal grandmother paralytic. 

122. Guinn — 5 years. Imbecility (pronounced). Pater- 
nal uncle inebriate. Paternal grandfather suicide and asth- 
matic. 

123. Georg — 4 years. Symptomatic idiocy. Mother ine- 
briate and maternal great-uncle insane. 

124. Buff — 16 years. Idiot. Maternal grandfather 
alcoholic. Maternal great-grandmother paralyzed. 

125. Norn — 7 years. Idiot. Father alcoholic and hys- 
teric and paternal grandfather paralyzed. 



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Selections. 225 

126. Franc — 13 years. Idiopathic epilepsy. Father 
alcoholic and paternal aunt insane. Paternal grandmother 
childish. 

127. Stof — 6 years. Complete idiot. Father inebriate. 
Paternal grandfather suicide (original). 

128. Dupu — 11 years. Congenital imbecility. Father 
inebriate and suicide. Paternal uncle inebriate and pater- 
nal great-grandfather suicide. 

129. Hue — 4 years. Alcoholism and imbecility. Father 
and uncle inebriates. Paternal grandmother cerebral rheu- 
matism. 

130. Heur — 10 years. Complete idiot. Grand- uncle 
inebriate. Grandmother exalted. Great-grandmother insane, 

131. Spor — 14 years. Imbecility. Father alcoholic. 
Paternal grandfather cerebral apoplexy. 

132. Cres — 18 years. Epilepsy, loss of intellect. 
Father alcoholic with general paralysis. Paternal grand- 
father mysterious. Paternal grand-uncle suicide, persecuted, 
and insane. 

133. Bri — 16 years. Hereditary epilepsy. Father and 
uncle alcoholic and paternal grandmother epileptic. 

134. Despaig — 15 years. Epilepsy. Father alcoholic 
and epileptic. Paternal grandmother hysteric and debauched. 
Paternal grand-aunt insane, and two paternal great-uncles 
suicides. 

135. Mor — 11 years. Imbecility,, epilepsy and deaf- 
ness. Father inebriate and paternal grandmother demented. 

136. Sim — 16 years. Mental instability and alcoholic. 
Paternal grandfather apoplectic and a suicide. Mother ner- 
vous, maternal grandfather apoplectic, 

137. Mor — 16 years. Alcoholic and epileptic. Father 
apoplectic. Mother nervous and irritable. Maternal aunt 
and great-aunt insane. 

138. Estes — 7 years. Symptomatic idiocy. Father 
alcoholic, and paternal grandfather paralyzed, and paternal 
uncle insane. 

139. Loi — 6 yearsl Alcoholic and epileptic. Mother 
nervous and epileptic. 



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226 Selections, 

140. Mott — 59 years. Epileptic and absinthic. Father 
died at 81. Mother senile dementia. 

141. Hers — 17 years. Pronounced imbecility. Father, 
excessive alcoholic and venereal, grandfather the same. 
Grandmother epileptic and insane. Uncle inebriate, aunt 
epileptic. Cousin- german epileptic. 

PREVENTION OF INSANITY.— THE DUTY OF PSY- 
CHIATRY AND THE STATE.— The German publicist. Dr. 
William Hirsch, has observed: "It becomes the task of 
modern Psychiatry not only to treat individual patients but 
also to observe society, and especially to guard against that 
phenomenon which ought to be termed Secular Hysteria, 
the peculiarity of which is that it attacks not isolated indi- 
viduals but epidemically entire communities, and in that 
way influences the development and metaphysical concep- 
tions of whole nations." 

Is there not a corresponding duty on the part of the 
State to deliberately mould its policy so as to render the 
community less and less susceptible to such attacks, an 
obligation which, when once recognized, would be fulfilled 
from considerations of public economy.' Such policy of pre- 
vention would extend to isolated cases. In our last Annual 
Report we ventured to refer to the importance of restrictions 
upon parentage. When congratulated upon the birth of his 
son, it is related that the father of Nero bitterly exclaimed: 
"The offspring of me and of Aggrippina can only be a 
monster who will scourge the world." It is a startling 
thought that society is still content to breed under the laws 
of Roman degeneracy. 

According to the modern doctrine of heredity it does 
not appear that it is a disease which is inherited, "but a 
diathesis, a predisposition, a want of resistance to all bale- 
ful influences of the direct, exciting causes of disease." 
This lack of resistance must be overcome by education. 
We have heretofore urged the extension of free instruction 
to the adult population by means of the school, the library, 
the lecture, the training in manual arts. It has been a 
theory of public instruction that the natural bent or incli- 
nation of the pupil should be watched for and developed. 



jdbyGoOglC 



SeUctions. 227 

Is it not evident that the theory is erroneous? We respect- 
fully invite the attention of your Honorable Board to the 
suggestion that the mental point of least resistance is the 
point of danger, and that our system of public instruction 
sliould be so directed as to bring up the laggard faculties 
of the pupil and set them into harmonious co-operation. — 
From Trustees Report, Pennsylvania Hospital for Insane. 



. PSYCHOTHERAPY. 

DANGER OF HOME ATTENTION OF THE INSANE.— 
In my report of 1894, 1 urged upon the citizens of Delaware 
the necessity of familiarizing themselves with the methods 
in vogue in caring for the insane and stated that a goodly 
number of cases were detained at their homes until they 
became dangerous to themselves and others, and then and 
then only they consented to allow them to be removed to a hos- 
pital. I cannot do better to instil this into the minds of the citi- 
zens of this State than to quote from the admirable work 
of M. R^gis on Mental Medicine: "The fundamental prin- 
ciples of the treatment of the insane is isolation. This 
consists in separating the patient from his habitual sur- 
roundings from contact with persons and things familiar to 
him, amongst whom he lives, and where its disorder had 
its birth and development. Nothing is worse than the 
detention of the patient in his own dwelling, and the con- 
tinuation of his stay amidst his family. There is, in such 
cases, the influences of the family on the one hand, an 
influence that Is injurious and prevents or delays the cure; 
and on the other hand the influence of the patient upon 
his family, which is not less hurtful, and sometimes, where 
there are children, actually dangerous. Moreover we must 
take into account the danger from an insane person, either 
to himself or to society, against which bis situation with 
his family affords only very insufficient guarantees. Isola- 
tion is, therefore, a measure of security and a powerful 
therapeutic agency" — Dr. Wm. H. Hancker, Med. Supt., 
Delaware State Hospital for Insane. 



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CLINICAL NEUROLOGY. 

HYSTERIA.— A Favorable prognosis not al- 
ways SAFE. — That a favorable prognosis is not always 
safe in hysteria, has been shown by Fournier and Sollier 
(Jour, de Med,), In some cases expectant treatment will not 
answer. Death may occur from spasm of the glottis. 
Fournier had a case with severe asphyxia in a young woman 
of twenty that was saved by faradism, but who afterwards 
had another attacK, in which she died. Where there are 
laryngeal manifestations in hysteria it is not safe to leave 
the patient to herself, Potain had a case of hysterical 
angina pectoris that died, and the post-mortem revealed 
nothing to account for the fatal result. In hysterical an- 
orexia, death also has been known to occur, even where 
artificial feeding has been resorted to. The system in such 
cases seems to have no power of absorption. Vaginal hys- 
terectomy is particularly dangerous in such cases, — Periscope, 
Medical and Surgical Reporter, February 6, 1897, 

KEROSENE IN ALCOHOLISM.— The most recent remedy 
for alcoholism in Russia is petroleum or paraffin oil, to which 
the notice of the St. Petersburg medical authorities was 
called by accident. It appears that a laboring man who 
had been drinking heavily for four days and nights entered, 
in a complete state of intoxication, a grocer's shop. Un- 
noticed by the shop keeper, he staggered up to an open 
cask of petroleum and began drinking from it. It is related 
that the petroleum cured him of all the effects of over- 
drinking; the nausea, unsteadiness of gait and headache 
disappeared as if by magic. — N. Y, Med. Times. 



NEURIATRY. 

THE TRAUMATIC NEUROSES IN THEIR MEDICO- 
LEGAL RELATIONS.— Dr. A. L. Hall, in a paper on this sub- 
ject, concludes as follows: 

1. The surgeon should be an equal authority with the 
neurologist in determining the sequences of trauma upon the 
nervous system. 



jdbyGoOglC 



Selections. 229 

2. Neurasthenia is the usual form under which traumatic 
neurosis expresses itself, and its symptoms are indistineuish- 
able from neurasthenia arising from other than traumatic 
influences. 

3. The actual condition of the patient previous to the 
accident must be known in order to reach a correct estimate 
of the damage from injury sustained by the nervous system, 

4. The type of symptoms manifested by the neurosis, 
whether neurasthenical or hysterical, is oftentimes a question 
of vital importance in the adjudication of a claim for damages. 

5. Traumatic neurosis occurs oftenest at the centres of 
population, but it is by no means a rare affection in the 
country districts. 

6. It is probable that traumatic neurosis is dependent 
upon some definite — yet unlinown — change in the arrange- 
ment and structure of the cellular elements of the nervous 
system, which gives rise to stable rather"* than unstable 
symptoms. 

7. A stable, well -organized symptom complex indicates 
damage to the nervous structures; while instability of symp- 
toms and want of orderly arrangement denote trivial injury, 
— and, if long continued, simulation is rendered probable. 

8. The so-called "objective symptoms" depend upon 
the psychical rather than the physical state of the subject, 
and are unreliable guides to diagnosis. 

9. A correct diagnosis is best obtained from a reliable 
account of the accident, the history of the previous state of 
the patient, the presence of surgical troubles, and the ex- 
istence of a stable, well-defined, organized symptom complex. 

10. The term "traumatic neurosis" is an expression for 
an indehnite condition, and a simplification of the subject 
is desirable from a clinical stand-point. — Medical Record. 

THE PUPIL IN Paresis.— Simerling (Berl. klitt. IVoch.) 
refers to the Argyll-Robertson phenomenon in the insane. 
In 3,000 cases of general paralysis (various observers) reac- 
tion to light was lost or diminished in 65 per cent. The 
symptom is an early one and of importance in the diagno- 
sis of general paralysis. Referring to the Argyll-Robertson 
phenomenon along with the lost knee jerks, lie remarks: "the 



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230 Selections. 

more advanced the disease the more these symptoms are 
found together. Permanent one-sided loss of light reflex is 
rare. The irregularity in the pupil in general paralysis is 
well recognized. Diminished reaction to light first occurs, 
then total loss, then paralysis to accommodation". In a few 
cases of general paralysis without tabes, Simerling has noted 
the phenomenon recorded by Cowers, namely, the pupil 
first of all reacts to light, then dilates and ceases to 
respond. The inequality of the pupils shows considerable 
variability of the pupils on different days. The pupils are 
usually stable in general paralysis. The phenomenon was 
also observed in 19 cases of senile dementia and even in 
old people of sound body and mind. It was present in 9 
cases of syphilis of the central nervous system, but was rare 
in chronic alcoholism. The loss of this reflex is an extremely 
important symptom, and even when it does not cause ser- 
ious misgivings 'ias to the presence of general paralysis, etc., 
it points to a disturbance in the central nervous system. 
General paralysis may supervene many years after the loss 
of the light reflex. The loss of this reflex undoubtedly con- 
stitutes one of the chief distinguishing features between 
epilepsia and hysteria. If the reaction is sometimes pres- 
ent in epilepsia, then, in the author's opinion, there is 
hystero- epilepsy. 

NERVOUS FUNCTIONS OF THE SUPRARENAL CAP- 
SULES. — Dominicis has already published various studies of 
the functions of the suprarenal capsules, and a recent article 
byjhim in the Gaietla d.Osp. e d Clin, of November 22, 1896; 
throws new light upon their connection with the nervous 
system. The experiments he describes on dogs and rabbits 
consisted in the transplantation of one capsule, after ligat- 
ing its pedicle, to the internal and anterior surface of the 
kidney, leaving its point of attachment intact. The animal 
remained in the same health as before. Ten to fourteen 
days later, he removed the other capsule, and in every case 
the animal died in three hours with the same symptoms as 
when both capsules are removed at once. The transplanted 
capsule showed no traces of degeneration, anatomically nor 
histologically, and seemed to be perfectly normal. Its func- 



jdbyGoOglC 



Selections. 231 

tion, however, was evidently suspended, and it was unable 
to take the place of ttie other capsule when it was 
removed, as occurs in the case of glandular organs with an 

internal secretion, when they are transplanted or ingrafted, 
the thyroid gland for instance. He adds his experience that 
section of the spinal cord below the level of the capsules 
invariably retards death for eighteen to twenty-six hours 
. when both capsules are removed at once. These facts 
demonstrate that we must look elsewhere than to an 
exclusively glandular function in ascribing a role to the 
suprarenal capsules. — Journal of A. M. A. 



NEUROPATHOLOGY. 

NEURASTHENIA AS A TOXIC NEUROSIS.— Experiments 
have shown that the sense of fatigue is due to poisoning 
of the cerebrum by the products of retrograde meta- 
morphosis. "The blood of a tired animal is poison, and when 
injected into another animal causes the phenomena of 
fatigue," Vigoreaux, in a monograph upon this subject, 
claims also that all neurasthenics are arthritics, basing this 
upon the analysis of the urine in one hundred and fifty 
cases. The urine was invariably found to be highly acid. 
Bouchard believes that it is due to gastro-intestinal auto- 
intoxication. Neurasthenia is sometimes a sequel of an acute 
infectious disease, as influenza or typhoid fever. 

In the first place, then, neurasthenia is due to a tox- 
aemia; due not to one, but to a variety of poisons. Tliese 
are sometimes bacterial in origin, as in cases following 
influenza or gastra-intestinal fermentations; sometimes the 
poison is uric acid, but most often the nervous system is 
poisoned by its own excreta — Dr. John Ford Barbour in 
American Praclilioner and News. 

[But in the neurasthenic constitution it is the neuras- 
thenia that permits the toxaemia to take place and persist. 
-Ed.] 



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EDITORIAL. 

[/4ll Unsigned Editorials are Written by the Editor] . 



Higher Medical Education is being continually sung 
in our ears by little men in the profession who happen to 
get onto State Boards of Health and wish to appear great 
by talking "large" on this subject, as if medical education 
had not steadily advanced most marvellously during the 
last few decades and as if the equipment of the leading 
medical schools were not constantly adding to their teaching 
facilities since the day when Benj. Rush founded the first 
medical college in this country, patterned after the best 
schools of Great Britain, and as if medical men in this 
country who teach in the best chartered colleges were all 
incompetent. 

It is a strange spectacle to see this everlasting notoriety 
seeking by medical men "clothed with a little brief author- 
ity," assaulting colleges ten fold better than those they 
graduated in, with facilities twice as great and far better 
qualified, equipments far more complete and terms of study 
lengthened to twice the time they spent as students. 

The little fellows of some State Boards are the most 
clamorous (or higher medical education, restrictive legisla- 
tion and discrimination against the diplomas of the best 
chartered colleges. 

The medical profession can not be trusted to exercise 
chartered rights, like other instructors, when instructors 
secure charters to teach, but must be subjected to additional 
espionage by state medical detectors called examining boards, 
and last comes a new proposition to examine the professors, 
as if faculties of honorable medical men and boards of 
trustees controlling our medical colleges required this spying 
system more than the literary and scientific universities of 
the land. But if the faculties are to be examined by a 
board of examiners, who will examine the examiners and 
attest their qualifications? 

Now we are opposed to this whole system of discrim- 

[232] 



jdbyGoOglC 



Editorial. 233 

inating espionage reflecting on the integrity and qualifications 
of the teaching element of the United States and it is a 
shame that it should come only from medical men, too, 
who are usually of exceedingly slender qualifications them- 
selves and who wish to appear great in their littleness by 
defaming American medical education, which, considering 
that it gels no aid from the state or people, and is in no 
sense a paying business to those engaged in it, is the best 
in the world and is m3i<ing more strides to-day in the 
direction of the very zenith of "practical utility than that of 
any other country. And what country has such institutions 
of medical teaching as the United States as sole result of 
personal professional effort, zeal and fmanctal support with- 
out state aid? 

Rush and Jefferson, the universities of Pennsylvania, 
Virginia, Minnesota, Michigan, Bellevue, Barnes, Baltimore, 
California, Tulane and in nearly every city and state are 
monuments of indefatigable medical devotion and largely 
disinterested sacrifice of medical time, talent and means, 
to advance medical education. Every large city on this 
continent has schools of which Americans may be justly 
proud, notwithstanding the notes of defamation and puerile 
cries of suspicion directed from various unhallowed motives 
against them. 

Defamation of American medical colleges by little med- 
iocrities in medicine has about reached the limit of tolera- 
tion by the friends of medical education in the profession. 

The question how to improve and advance is always in 
order, but late methods of public defamation of American 
schools is dispicable and disastrous to the welfare of the 
whole medical profession and should be discountenanced and 
discontinued. 

State boards and schools should arbitrate differences 
and not antagonize. 

Program of the Section on Neurology and 
Medical Jurisprudence of the American Medical 
Association. — Tuesday, June 1st. — Chairman's Address, 
Dr. W. J. Herdman, Ann Arbor, Mich.; History of the 
Section on Neurology and Medical Jurisprudence, Dr. J. G. 
Kiernan, Chicago; History of American Neurology, Dr. C. 
H. Hughes, St. Louis; On the Pathogenesis of Locomotor 
Ataxia, Dr. L. Harrison Mettler, Chicago; Trunk Anaesthe- 
sia in Locomotor Ataxia, Dr. Charles W. Burr, Philadelphia; 
The Paralyses, by One of the Many Paralytics, Dr. Samuel 
Knox Crawford, Chicago; Internal Cerebral Meningitis 
Chronica, Dr. E. S. Pettijohn, Alma. Mich.; The Differ- 



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234 Editorial. 

ential Diagnosis between Cerebral Syphilis and General 
Paresis, Dr. Hugh T. Patrick, Chicago; Hereditary Lateral 
Sclerosis, Dr. Augustus A. Eshner, Philadelphia; A Case 
of Thomsen's Disease Complicated by IWultiple Neuritis, 
Ur. M. Nelson Voldeng, Des Moines, Iowa; Pain Traumat- 
isms, Dr. Thomas H, Manley, New York City; Melancholia 
and its Treatment, Dr. W. S. Watson, Fishklll-on-Hudson, 
N. Y. 

Wednesday, June 2nd, — Aphasia, Dr. Charles K. Mills, 
Philadelphia; Discussion, Drs. F. X. Dercum, Hugh T. 
Patrick, William G, Spiller, Barney Sachs, J. J. Putnam, 
C. W. Burr and W. J. Herdman; French and Motor 
Aphasia in a Polyglot, Dr. Frederick Peterson, New York 
City. The Subconscious Mind, Clark Bell, Esq., New 
York City; Some States of Disturbed Consciousness, 
Dr. J. T. Eskridge, Denver, Colo.; Expertism, Dr. S. V. 
Clevenger, Chicago; A Synopsis of the Duestrow Case, 
Dr. L. Bremer, St. Louis; The Medico- Legal Aspect of 
Choreic Insanities, Dr. C. C. Hersman, Pittsburg, Pa.; 
Insanity and Pulmonary Consumption Among the Negro 
Population of the South Since the War, Dr. Thomas J. 
Mays, Philadelphia; Remarks on the Curability of Insanity, 
Dr. John Punton, Kansas City, Mo.; (a) Alcohol as a 
Causative Factor in Disease of the Central Nervous Sys- 
tem. {*) Inebriety and Tuberculosis as Allied Diseases, 
Dr. T. D. Crothers, Hartford, Conn.; The Status of the 
Present Treatment of Alcoholism, Dr. J, K. Bauduy, St. 
Louis; Stigmata in Young American Degenerates, Dr. 
Eugene S. Talbot, Chicago; Some Affections of the Sym- 
pathetic Nervous System, Dr. Jas. Hendrie Lloyd, Phila- 
delphia; Subject un-announced, Dr. Henry W. Coe, Port- 
land, Oregon. 

Thursday, June 3rd. — Neurasthenia Essentialis and 
Neurasthenia Symptomatica, Dr. F, X. Dercum. Philadel- 
phia; A Study of the Symptomatology of Neurasthenia 
in Women, Dr.. Louis F. Bishop. New York City; Clin- 
ical Evidences of Neurasthenia as an Abdominal Neuro- 
sis, Dr. G. Betton Massey, Philadelphia; Function of the 
Nerve Cell, Dr. Wm. B. Hall, Jr., Sewanee, Tenn.; The 
Causative Factors in Disease of the Central Nervous Sys- 
tem, Dr. Geo. H. Rohe, Sykesville, Md,; The Use and 
Abuse of Electricity in the Treatment of the so-called Neu- 
roses, Dr. L. Harrison Mettler, Chicago; The Rest Cure, 
Dr. Landon Carter Gray, New York City ; Discussion : 
Drs. Chas. K. Mills, E. S. Pettyjolin and C. H. Hughes; 
Rest and Northern Lake Air for Neurotics, Dr. E. S. Pet- 



jdbyGoOglC 



Editorial. 235 

tyjohn, Alma, Mich.; Treatment of Graves' Disease, Dr. 
Herold N. Moyer, Chicago; Discussion: Drs. A. A, Esh- 
ner, and C. H. Hughes; Habit Spasms of Children, Dr. 
Samuel J. Fort. Ellicott City, Md. ; A Study of the Devfeiop- 
ment of Some Common Psychoses of Cliildhood into Perman- 
ent Criminal Tendencies, Dr. J. Francis Calif, Middletown, 
Conn.; Subject Unannounced, Dr. H. O. B, Wingate, 
ittilwaulfee. Wis. 

Friday, June 4th. — *Tumor of the Spinal IV\eninges, 
Drs. Charles K. Mills and Aloysiiis O. J. Kelly; *(a) 
Fibroma of the Dura, (b) Syphiloma of the Dura, (c) Glioma 
of the Thalamus, Drs. Chas. W. Burr and Aloysius O. J. 
Kelly; *Tumors of the Cerebellum with the Report of a 
Case, Dr. Aloysius O. J. Kelly; *A Clinical and Pathological 
Report of a Case of Chronic Progressive Non- Specific 
Dementia with Arterio-Sclerosis, Drs. Charles K. Mills and 
Mary Alice Schively; *A Case of Paretic Dementia witli 
Autopsy, Dr. Charles W. Burr and John H. W. Rhein; 
*Tumor of the Basal Ganglia, Drs. Charles W. Burr and 
Carl Ohnesorg; *Tumor of the Spinal Meninges, Drs. 
Samuel W. Morton and A. Ferree Witmer; Bilateral Psycho- 
motor Myo- Synchrony, Dr. C. H. Hughes, St. Louis; Men- 
ingo-myelitis with Special Reference to the Tubucular Form, 
Dr. William G. Spiiler, Philadelphia; {a) A Contribution 
to the Pathology of Myelitis, Acute and Chronic, (b) Lesions 
of the 'Spinal Cord Due to Tubercular Disease of Column, 
With Microscopic Specimens, Drs. John K. Mitchell and 
Jonn H, W. Rhein, Philadelphia; Rumination in Man, Dr. 
Wharten Sinkler, Philadelphia; Tremor in Chorea, Dr. John 
H. W. Rhein, Philadelphia; Hypnotism in the Treatment 
of Disease, Dr. U. O. B. Wingate, Milwaukee, 

Typhoidous Spates.— After Woodward receded from 
his attitude on typho-malarial fever and Da Costa objected to 
the term typhoid-pneumonia, etc.. American medical teachers 
and authorities began to drop the use of the term. We 
think this was a mistake. There are states of nervous 
exhaustion like those which accompany typhoid fever, with- 
out the coexistence of this fever with its characteristic 
enteric feature, for which we need a descriptive term. These 
are real typhoidous states without the implication of Peyer's 
patches. They are nervous typhoid conditions minus involve- 



jdbyGoOglC 



236 Editorial. 

ment of the elliptical plates. They are true typhoidous states, 
as much entitled to be so regarded because of the exhaustion 
resemblance to the typoid fever accompaniment, as true 
typhoid is to the typhus, after which it is named because 
of its symptomatic resemblance, and from which it is differ- 
entiated because of its distinctive intestinal pathological 
contrast. Then let us have a typhoidous pneumonia, a 
typhoidous malarial fever, and a typhoidous nervous exhaus- 
tion or a typhoidous malarial neurasthenia, with the under- 
standing that the true typhoid sign is not a factor in the 
cases. We need such a term for descriptive papers, because 
such states are clinical facts. 

Kleptomania and the Case of Mrs. Castle. — 

The Humanitarian comments with some justice on this case, 
though we by no means go to the extent of considering 
crime as "generally a form of insanity." 

"The case of Mrs. Castle is one of those which illus- 
trates every now and then the crying need of reform in 
our criminal law. Her case was one for the psychol- 
ogist rather than the bribed juryman; for the doctor rather 
than the judge. The Home Secretary recognized this, by 
promptly commuting her sentence, which was tantamount to 
a. confession that she never ought to have been sent to 
prison at all. The whole question of crime and criminal 
tendencies needs overhauling from a scientific point of view. 
To treat it merely from the Old Bailey aspect is 'brutal, 
ignorant and ineffective. Half the unhappy beings who are 
hauled before our Police Courts should be dealt with by 
scientists rather than by lawyers. Crime is generally a 
form of insanity. And this is especially true of kleptomania, 
which is far more widespread than most people imagine. 
There is no need to mention names, but it would be easy 
to call to mind many eminent personages who have been 
afflicted with this disease, which numbers its victims largely 
among women." 

In this case the inconsistency appears of a bail fixed 
at 40,000 pounds as an equivalent for three months' depriv- 
ation of liberty. 

The Medico-Legal Journal of New York has an interest- 
ing abstract on this subject from Prof. Lacassagues before 
the Congress of Criminal Anthropology in whose views 
however we do not fully concur. 

There is a definite line between normal theft and 
abnormal stealing or kleptomania, and that is in the voli- 
tionally regulated promptings of healthy but wrong motive 
and the resistless impulsions of disease. The disease is often 



jdbyGoOglC 



Editorial. 237 

inferable in the character and motive of the thefts and 
almost always provable in the physio-mental disease of the 
victims of kleptomania. 

Lacassagues makes a move in the right direction in his 
resolution recommending that the large stores exert greater 
surveillance and place less temptation in the way of those 
mentally and neurotically weak creatures who under great 
temptation may develop into either thieves or kleptomaniacs, 
for there are both, and both may be found among the rich 
and the poor. 

The National Medical Review very justly expressed its 
surprise that some of its exchanges have inclined toward 
London Truth in its discussion of the sad case of Mrs. 
Castle. It says: "A* our readers know, this London 
journal took the position that it was only the rich who 
were ever afflicted with kleptomania, while the poor were 
always regarded as thieves. Both Truth and some 
American journals appear to forget that one of the 
strongest evidences is that the party committing the theft 
has no need of the things stolen. If the person who takes 
the goods is poor this would not be the case, for even if 
the goods could not be used they could be readily disposed 
of at a good figure. So strong are the temptations con- 
nected with poverty that it would be difficult to imagine 
that a person in need would store away in her room a large 
number of goods which could be readily sold or pawned and 
the proceeds devoted to satisfy comfort and hunger. We 
do not remember ever having heard of an instance where a 
person in need of food and clothing stored away quantities 
of goods in this way. On the other hand, we have one 
who is supplied with every need, and is surrounded by 
everything which money could purchase in order to make 
life happy and pleasant. Such a person has no possible 
use for a large number of articles of one kind. Well fed, 
richly clad, surrounded with luxury, there can be no temp- 
tation to take articles of small value, either for use or in 
order that they may be sold. We think there is every 
good reason to believe that kleptomania IS a disease which 
affects the rich more than the poor." 

Tri-Statc Medical Society of Iowa, Illinois and 
Missouri, held a well attended and successful meeting at 
St. Louis, on the 6th, 7th and 8th of the present month. 

The following officers were elected: Dr. Emory Lan- 
phear. President; Dr. C. E, Ruth, of Keokuk, Iowa, First 
Vice-President; Dr. E, Wyllis Anderson, Chicago, Second 
Vice-President; Dr. J. W. Fowler, Dubuque, Secretary; 



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238 Editorial. 

Dr. C. S. Chase, Waterloo, Iowa, Treasurer. Dubuque was 
selected for the next place of meeting. 

New Pathological Department. — The Indiana Hos- 
pital for the Insane announces, with ground plan and eleva- 
tion, the finishing of its elegant and complete pathological 
department, whereon the superintendent, Ur. Geo, F, Eden- 
harter, justly remarks: "It is a great credit not only to the 
State, but reflects the greatest wisdom on the part of the 
Board of Control. The benefits to the people will be very 
great." 

This is not only a great credit to the State but a great 
credit to science and the welfare of the insane, promising 
more light on the dark processes of c«rebro-i1ientaI disease and 
opening the way further for the lifting of the cloud that 
hangs over mental aberration. 

National Confederation of State Medical 
Hxamining and Licensing Boards. — The seventh 
annual meeting of this Coi]federation will be held In the 
small banquet hall of the Hotel Walton, at Philadelphia, 
Monday, May 31, 1897, at 10 o'clock, A. M. 

The object of the confederation is to consider questions 
pertaining to state control in medicine and to compare meth- 
ods in vogue in the several states; the collection and dis- 
semination of information relating to medical education, and 
to consider propositions that have for their purpose advance- 
ment of the standards in the United States. A cordial invi- 
tation is extended to all members and ex-members of state 
medical examining boards, and to physicians, sanitarians 
and educators who are friendly to the objects named, to 
attend the meeting and participate in its proceedings. 

Officers: President, Wm. W. Potter, Buffalo. N. Y.; 
Vice-Presidents, Chas. A. L. Peed, Ohio, J. N. McCormack, 
Kentucky; Secretary and Treasurer, A. Walter Suiter, Her- 
kimer, N. Y. 

Hobart A. Hare. — Messrs. Parke, Davis & Co. 
announce the complete equipment of a Pharmacological and 
Bacteriological Laboratory fur the careful testing of all their 
drugs and antitoxic serums, and tliat they have retained the 
services of Dr. Hobart A, Hare, Professor of Therapeutics 
and IVlateria Medica in the Jefferson Medical College, Phila- 
delphia, as Consulting Therapeutist for their house. Dr. 
Hare will undoubtedly prove an invaluable acquisition, as 
this firm believes, to its Medical Staff as all que.stions relat- 
ing to the practical value of new and old remedies, and to 
the relative merit of various preparations, will be referred 



jdbyGoOglC 



Editorial. 239 

to him for an opinion. The profession may congratulate 
itself that its interests will be well looked after with Messrs. 
Parke, Davis & Co. The gentlemen in charge of their 
Biological Department are Dr. Charles T. McClintock and 
Dr. E. M. Houghton, formerly of the University of Michi- 
gan. They will continue to supervise the manufacture of 
their bacteriological agents, test their pharmaceutical prod- 
ucts, and investigate the physiological action of new reme- 
dies. Though the laboratory worker is not in position to 
speak the last word on the remedial value of therapeutic 
agents, such researches, supplemented at the bedside and in 
the hospital by searching study of the clinical behavior of 
drugs and the indications for their use, is what the profes- 
sion requires from its therapeutic caterers. 

Parke, Davis & Co. are keenly mindful of this vital 
connection between scientific research and actual bed- 
side results, and appear to profit by every resource which 
may contribute to the potency, the uniformity and the reli- 
ability of their products. 

The Profession will recognize the earnest progressive 
spirit of this great northern firm. 

Apbusia Medico-Legally Considered. — The Medi- 
cal Press remarks that, "it is quite possible that in due course 
of time the question of whether aphasia constitutes a legal 
disability in the case of a patient making a will, will be 
brought forward for decision. Dr. Mantle, of Halifax, has 
just recorded a case in which an aphasic patient of his made 
a last will and testament under certainly unusual circum- 
stances. The patient formed the outline of the letters on 
the bed-sheet with his finger, and then explained to his 
solicitor and wife that when they meant "y^s" they were 
to squeeze his hand, and when they meant "no" to tap it. 
In this manner the testator was able to have his wishes 
incorporated in a will, which he subsequently signed with 
his left hand. Of course the point upon which the legality 
of the document will depend is, whether there is sufficient 
evidence to show that the mental condition of the patient 
was satisfactory at the time that the will was drawn up 
and signed. As such point has never been raised before, 
the matter is one of no little interest." 

A similar point has been raised before and affirmatively 
settled in tlie courts of St. Louis in the case of Wm. T. 
Bevan, reported by the editor of this journal, which we 
reproduce, wherein the writer, with other physicians, main- 
tained the affirmative of the proposition and they were 
sustained by evidences before the jury and the jury's 



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240 Editorial. 

decision. The subject of aphasia was then comparatively new, 
and its literature far less than at present, while the knowl- 
edge of this subject was less extensive, definite and elabor- 
ate than now appears from the later researches of Bartholow, 
Mills, Eskridge and others in this country, to say nothing of 
European contributors, which, however, have not equalled 
those of American writers, if we except the physiological 
experimentations of Heitzig, Ferrier and others. 

Change of Address. — The Columbus Medical Journal 
has removed from 150 E. Broad Street to its new quarters, 
58 Buttles Avenue, Columbus, Ohio. 

A Study ill Morbid Egoism. — Under an entirely 
different caption and not for a purpose wholly different from 
this editorial, our esteemed seaboard contemporary, the 
Boston Medical and SuTgicalJoumal, thus discourses: 

"From time to time the enraged practitioner, or the sta- 
tistically inclined editor of a medical journal, raises his voice 
in melancholy plaint and inveighs against the dread evil of 
Hospital and Dispensary into whose hungry maws, ever 
insatiable for material, he sees disappearing day by day 
the last remnants of the 'general practitioner's' clientele. 
To him no words are strong enough to express his condem- 
nation of 'misguided charities'; and in the blindness of 
his rage he totally overlooks a far more formidable antago- 
nist, who stands between the public and himself and takes 
more dollars from his pockets than any hospital clinic that 
ever existed. We refer to the wily patent- medicine man. 
Backed by the testimonials of a host of so-called 'cures,' 
both male and female, selected from the most prominent 
walks of life, he probably accumulates more money in a 
month than the average medical practitioner does in a year, 
for at no time within our memory has the craze for exhib- 
iting their photographs with a neatly-worded and convincing 
testimonial appended as the virtues of this, that or the 
other quack nostrum, been so rife among people whose 
names are household words all over the country and whose 
influence among the masses is widespread. The unblushing 
manner in which women disclose to the genera! mass of 
readers of the daily papers the pathological workings of their 
genito-urinary apparatus and the marvelous relief which 
they obtain — as evidenced by the redundancy of mammary 
tissue exposed in the accompanying wood-cut — by merely 
purchasing a bottle of Mrs. Allslop's Ovarian Stimulator, after 
they have been for months exposed to the ruthless fingers 
of all the best-known gynecologists, is enough to bring a 



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Editorial. 241 

flush to the cheek of a pernicious anemic — but it doesn't, 
it simply sends hundreds of other suffering females in search 
of this wonderful remedy for their self -diagnosticated com- 
plaints. 

"Not a day passes but the lay press contains a villainous 
reproduction of the face of some well-known divine, accom- 
panied by a testimonial overflowing with exuberant grati- 
tude for the remarkable manner in which Dr. Charcoal's 
Tablets have enabled him to overcome the ravages of a 
deadly disease whose nature was so obscure that it defied 
the skill of the most renowned specialists even to determine. 
Cheek by jowl with him will be imprinted the philanthropic 
features of some famous temperance advocate who testifies 
in language whose sincerity is beyond a doubt, that it is 
only through the constant use of Brown's Nervine Invigor- 
ator (mainly proof-spirit with a dash of gentian and nux) 
that he is able to withstand the strain upon his nervous 
system incident to his vigorous onslaughts upon the demon 
Rum. 

"Next to the pulpit, the stage furnishes the greatest 
number of promising wrecks who have been snatched from 
an untimely grave— or from the lunatic asylum, more's the 
pity! — solely by the use of Someone's Malt or So-and-So's 
Wine, the secret of whose virtue is beyond the chemist's 
art to discover, but which probably owe their wonderful 
therapeutic value to the fact that they are a little more 
stimulating than beer and a trifle less paralyzing than 
absinthe. It will not be overstepping the narrow bounds of 
truth to say that there is hardly an actor or actress, singer 
or songstress of any repute to-day, for whose power to 
entertain we are not indebted to the magic influence of some 
patent nervine or reconstructive 

"Even the legal profession is not loth to lift its voice to 
swell the chorus of praise for services rendered by the 
various prominently ad.vertised nerve-foods and panaceas: 
and not a few eminent law- makers unconsciously — but 
clearly — explain, in the exhaustive symptomatology which 
they detail of their sufferings previous to their use of one 
of these panaceas, that pecCiliar flavor of general paresis so 
characteristic of certain statutes governing the practice of 
medicine, 

"Now that athletics stand so conspicuously before the 
public, we are everywhere confronted by the beautifully 
portrayed musculatures of crack athletes who owe their 
wonderful powers of endurance to an occasional nibble at 
Blank's Comatogenous Biscuits washed down by two or 



jdbyGoogle 



242 Editorial. 

three drops of Somebody's Kola Preparation to whose su- 
periority as a preventive of undue tissue waste, the lavish 
supply of muscles in which the athlete rejoices abundantly 
attests. 

One cannot sit down in an electric car without being 
confronted by a galaxy of lithographic beauties singing the 
praises, in rubricated rhyme, of coal-tar products or cold 
cream; and beside them one beholds the smiling and 
scorbutic countenance of a banker's or a merchant's child 
— money no object — whose once feeble frame was coaxed 
into vigorous activity by some patent food, after it had 
nt;arly succumbed to the misdirected onslaught of the best- 
known pediatrists. 

"The effect of all this upon the general public can be 
easily imagined. If the Rev. Dr. This or the Hon. That 
has been cured by somebody's nostrum, or if their babies 
are able to thrive vigorously on a patent food, why shouldn't 
the humblest of these gentlemen's admirers and their babies 
do the same' They try one bottle — and keep on buying 
just as they keep on buying lottery tickets, until their 
money is exhausted, and then — too poor to employ even the 
general practitioner, they turn in desperation to the dispen- 
sary and hospital clinics where they faintly hope that they 
may come in contact with some specialist who will, by 
mere bull-luck, be able to stumble upon a remedy for their 
complaint. Let the general practitioner be content!" 

With the addition of certain obscure proprietary medi- 
cine enthusiasts who tell the most wonderful and unguarded 
stories of remarkable success with impossible clienteles and 
often impossible dosages compatable with continuing lives to 
imaginary patients, the above picture of notoriety egotism 
(to use no harsher term), is'complete. The egotism that 
prompts many of the improbable statements attending the 
(unpossessed) powers of some of the numerous ines. etc., 
on the medical market, when not positively venal and mer- 
cenary, is often absolutely morbid, and a prelude in some 
cases to mental doom, as the certificates themselves are 
Prima facie evidence of that mental weakness which is 
precursory of cerebral softening. 

The Rights of the Insane in State Hospitals. 

— Since the foundation of this Government, when the divine 
prerogative of kings to oppress their people was denied and 
it was declared that all Governments among men derive 
their just powers from the consent of the governed, declar- 
ations in state bills of rights have been made and statutes 
have been framed for the protection of the governed against 



jdbyGoOglC 



Editorial. 243 

the executive and other official oppression. State after 
state, our own Missouri among them, has reiterated the 
affirmation of thtf fathers of the Declaration and the Con- 
stitution, until now the rights of sane people are pretty 
well secured, except the steady encroachment on individual 
rights to liberty of business by combined capital, which, 
lil<e the usurers among the money-changers of old, should 
be and will be similarly restrained and regulated by lew. 
We have, in the main, as a people, made good the declar- 
ation of our fathers, that men have precious rights, and 
Governments and Governors are created among men to 
protect and defend these rights. So much for the rights of 
the rational. 

But how about the rights of the insane? When a citi- 
zen, who in his best estate, has helped to sustain the elee- 
mosynary institutions of his commonwealth by faithful exer- 
cise of his franchise and the payment of his taxes, falls 
mentally maimed in the battle of life, is carried to the rear 
and is placed in the hospital for the insane, he has helped 
to provide; if he belongs to that large army of men, who, 
for himself and his household, employs one or more of the 
5,000 regular physicians of the state to minister to his 
health, when he or his wife or child, or other kindred, 
becomes insane, must he have forced upon him medical ser- 
vice which, in his sane estate, neither he nor his family 
would have approved? Has he lost his rights with his rea- 
son? The state stands in his stead as though he were 
sane, and has no more right to force upon him obnoxious 
medical service than to force food upon him which he could 
not tolerate when rational. The state and the law should 
guard his rights to life and happiness according to his sane 
ideas. 

The curator or guardian of an insane man, who accepts 
for his insane ward the medical attention of the votary of 
sectarian medicine, homceopathist, eclectic, Thompsonian, 
vitapathist, osteopathist, mind or spirit healer, which his 
ward would not have accepted for himself If sane to choose, 
violates the right of that man, even though he be now 
insane. It is not necessary to quarrel over the claimed 
merits of the isms and pathies in medicine. The question 
of sectarian medical aid to non-sectarian insane people is 
not a question to be entertained in the premises. 

Another right belonging to the insane is the right to 
receive at the hands of the state every aid promotive of the 
speediest possible recovery of this mind. To this end the 
statutes of many states now provide that the physician 



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244 Editorial. 

whom the Governor may select as medical chief of state 
asylums shall not t>e a tyro or a novUe in psychiatry. 
The rights of the insane require, and in the name of those 
helpless wards of the state who by grave affliction are 
incapacitated from maintaining their rights, a Nineteenth 
Century humanitarianism demands, as their friend, that 
their rights in this regard be respected by their guardians, 
the state and its executive. It is a crime against their 
rights in the premises to place them under the medical care 
of men without adequate special experience in this most 
intricate branch of medical practice. These rights of the 
insane the state should be bound to respect, and it seems 
to me that the courts could enforce them. The superin- 
tendent of a hospital for the insane should be a man who 
has lived among them and learned well how to treat them. 

"The treatment of insanity," says a great authority, 
"is now so much confined to the heads of extensive estab- 
lishments in which its subjects are congregated, that oppor- 
tunities for studying it are comparativelv limited in ordinary 
practice, so that a physician may be justly celebrated in 
the knowledge and treatment of other diseases, and at the 
same time be poorly qualified in matters pertaining to 
insanity." 

Again he says: "Physicians are frequently unwilling 
to believe it" (as we see every day by the way they rush 
into court with these crude unsustainable theories) "and are 
disposed to act on the popular notion that all medical sub- 
jects are equally familiar to them." 

These rights of the insane are but the golden rule 
applied, and if you but reflect upon them, most excellent 
Governor, your heart will approve them. If you wish to 
understand this question look into your own heart and you 
will see that justice demands the recognition of these rights. 
Your official oath demands of you to guard, and not to vio- 
late, to protect, and not to invade, them." 

The statutes of Missouri say "the superintendent shall 
be a physician of knowledge, skill and ability in his pro- 
fession and of special skill and experience in the care and 
management of the insane." 

This article is inspired by an attempt on the part of 
the Governor of Missouri to turn over an old institution 
under regular management to the homceopathists. It con- 
cedes all it asks, namely, the political right of people of 
the homceopathic faith having a separate hospital if any 
considerable number of that faith ask for such an institution. 



jdbyGoOglC 



Editorial. 245 

The Setni'Ceatenmal Meeting of the American 
Medical Association, which will be held in Philadelphia 
on the 1st, 2nd, 3rd and 4th of June, 1897, bids fair to surpass 
in the character of the entertainment, the scientific papers and 
the number in attendance, any meeting which has hereto- 
fore been held. The Committee in charge has been able 
to obtain large and roomy places of meeting for the general 
meetings and the section meetings, all within a single block, 
and within very short walking distances or immediately 
adjacent to the largest and most comfortable of the Phila- 
delphia hotels. 

For the week preceding and following the meeting the 
Committee of Arrangements have also arranged for clinical 
courses which will be open without charge to all physicians 
who may visit the city at that time. These courses cover 
every branch in Medicine and its specialties and will afford 
visitors the opportunity of seeing the active clinical work of 
all the great teachers of Philadelphia, which is now, as it 
has been for so many years in the past, in every respect 
the medical centre of the United States. 

Poetic Therapy. — It is seldom we find poetry and 
physic blended. Dr. Frederick B, Sutton has "set on" 
Frank Ruf's Antikamnia in the following poetic fashion: 

A-lt the nerves gone on a bender, 

N-ot an organ Is exempt, 

T-eeth and scalp and muscles tender. 

l-cy chills, the bones pre-empt; 

K-aleldoscopfc are the symptoms legion, 

A-s they over-run the system, 

M-akIng llle a weary region. 

N-o one able to resist them. 

l-s there nothing that wilt cure? 

A-ntikamnIa will, I'm surel 
Bi-Lateral Psychomotor Myosynchrony. — A case 
of this kind atavically descended from a grandfather has 
fallen under our observation in the person of a girl about 
sixteen years who cannot move the fingers of one side 
without the corresponding fingers of the other being sim- 
ilarly moved, and who could not learn to play the piano in 
consequence. 

We think Erb has somewhere described a case or cases 
of this kind, but do not know when or where, or what he 
called them. For want of a better name, we designate this 
condition bilateral psycho-motor myosynchrony, the muscles 
moving in synchronous manner when a psycho- motor impulse 



.dbyGoot^le 



is directed to but one side. The patient is not ambidex> 
trous. 

American Public Health Association, compris- 
ing tlie United States of America, tlie Dominion of Canada, 
and tl)e Keptiblic of Mexico, will iiold its twenty-fifth annual 
meeting at Philadelphia, Pa., October 26th, 27tfi, 28th and 
29th, 1897. 

Medico-Psychological Association of Great 
Britain and Ireland. — The next annual meeting of this 
association will be held in Newcastle, at the College of 
Medicine, in the latter part of July. Notice of the dates and 
other particulars will be issued in due course. 

A considerable part of the time, of the meeting will be 
devoted to discussions, papers, and demonstrations, on sub- 
jects connected with insanity and the structure and func- 
tions of the brain and nervous system. The president, T. 
W. McDowall, M. D., Northumberland County Asylum, 
Morpeth, and Hon. R, Percy Smith, M. D., Gen. Secretary, 
11 Chandos Street, Cavendish Square, London, W., will 
be glad to receive at an early date the title of the paper 
which any member proposes to read at the meeting, or sub- 
ject he designs to bring before it. 

Gayety and Gloom. — A visitor to a lunatic asylum, 
seeing therein a former friend and noted wit, expressed his 
surprise that one formerly so jovial should now appear so 
depressed, for his friend was a victim of profound melan- 
choly. Thereupon the victim of melancholy replied: "It 
was then my business to make people laugh. My business 
exhausted me and i am tired of it and of life." 

The daily press has not failed to note that excessive wit 
making may exhaust the brain, as well as excesses of other 
sorts. The people of the gay French Capitol have lately 
noted the fact, and their newspapers ask: "Where are the 
leading French humorists of the last twenty years? Gil- 
Perez, an eccentric comedian on and off the stage, died 
mad; Andre Gill, a caricaturist of undoubted genius, went 
the same road, as did also Charles Desteuque, one of the 
liveliest spirits of the boulevards. Rhoul Foche, who delighted 
Paris with his comic dramatic criticism, committed suicide, 
and the same fate cut short the famous practical jokes in 
society of Lemice Terrieux." 

The Globe -Democrat, of St. Louis, commenting on this, 
thinks absinthe has something to do with this dire result, 
but the brains of men break under the excessive strain of 



jdbyGoOglC 



wit as well as wisdom, of worry and wrong, without remis- 
sion, as well as vice. Respite and rest betimes, constitute 
one of the laws, at least, of physiological integrity. 

Meeting of American Medical Publishers' 
Association. — The Fourth Annual Meeting of the Ameri- 
can Medical Publishers' Association will be held in Phila- 
delphia, on Monday, May 31st, 1897. 

Tennessee Centennial and International Expo- 
sition, Nashville, Tenn: — The Centennial and Inter- 
national Exposition to celebrate the one hundredth year of 
statehood by the citizens of Tennessee is now open. A 
separate and special building for medical and surgical appli- 
ances and hygiene has been provided, for everything per- 
taining to these sciences and arts. This building will be 
specially attractive to the many medical men who will be 
in attendance from all parts of the world at some time 
during the season, A dozen or more prominent medical 
organizations have signified their intention of meeting in 
Nashville during the Centennial, as well as many doctors 
who are in aflfiliatton with other orders, societies and 
organizations that will meet here. 

DEERING J. ROBERTS, Chairman. 

The Medical Staff of the Illinois Eastern Hospital ' 
for Insane has given a course of instruction to the Training 
School for Nurses throughout the winter months, with an 
intermission of two weeks for Christmas holidays. , 

Charles VI., of France, was afflicted with melancholia 
and was, in fact, almost incurably insane. To interest and 
amuse him, the game of cards was introduced at court in 
1392. 

Illinois Eastern Hospital for Insane. — During 
the winter, W. O. Krohn, Ph. D., Professor of Psychologv, 
University of Illinois, Champaign, lectured once a wt-ek 
to the Medical Staff of this institution on Physiological Psy- 
chology, illustrating his lectureswith laboratory experiments. 

Physical Rest Versns Gymnastics after Study. 

— Baum in a recent number of the Therapeut. IVoch. main- 
tains that mental fatigue is increased by muscular exertion 
and that such fatigue is best dissipated by both physical 
and mental rest, and we are in full accord with him in his 
assault on muscular gymnastics of school children now so 
much in vogue in our public schools immediately after books 



jdbyGoogle 



248 Editorial. 

are laid aside, and maintain on principles of cerebro*therapy 
after mental strain, that the practice is bad fiygiene. Brain 
fatigue is best dissipated by giving the psycho - motor cen- 
ters, as well as other portions of the cerebral cortex, a 
proper period of rest immediately after great mental labor. 

The Physician as a Citizen. — There is no doubt 
that medicine requires not only close and constant devotion 
to study, but that the physician shall be within ready call 
of those to whom he has undertaken to minister. It is 
quite evident, therefore, that close and continuous devotion 
and engrossment in public matters and the undertaking of a 
large share of the direction of political movements is incom- 
patible with the active practice of the profession. So much 
being granted, however, it is also quite evident that a phy- 
sician may, without detriment to his professional studies, 
and without neglect of his patients, give a portion of his 
time and thought and action to the public welfare; how 
much and how applied, circumstances and individual dis- 
cretion must determine. — Philadelphia Polyclinic. 

Meeting of the Missouri State Medical Asso- 
ciation. — Present prospects are that the meeting of the 

Missouri State Association this year will prove very satis- 
factory. The committees have all gotten to work early 
which is a good indication. The committee on scientific 
communications is already in receipt of titles in numbers 
and character sufficient to insure the. programme scientific- 
ally attractive. The executive committee is enabled to 
announce the following programme, the details of which 
only remain to be completed. The association will meet in 
St. Louis May 18th. 19th and 20th. All the first, the sec- 
ond and the third day until noon will be devoted to the 
scientific programme. On the evening of the first day the 
association will as a body attend a session of the Illinois 
Society in East St, Louis. On the evening of the second 
day the Illinois Society will attend as a body a session of 
the Missouri Association, after which there will be a ban- 
quet and reception. On the third day both bodies will 
adjourn and join a steamboat excursion on the river. 

Toxic Neuriatry promises to become an interesting 
and fruitful source of light in neuropathic states and symp- 
tomatic expressions of nervous disease. The microbean view 
of tetanus and some forms of the neurilides. alcoholic poly- 
neuritis and insanity, the paralysis of saturnism, the ve- 
nereal, rheumatic and gouty neuroses, and the ancient afra- 



id byCoOglc 



Editorial. 249 

biliary theory of melaticbolta, have paved the way for the 
later theories of autotoxine epilepsy, melancholia, insanity, 
etc. Dr. Von Geisen, in the Slate Hospitals Bulletin of New 
York, has talten up this subject and is now investigating the 
toxic condition of the cerebral cells in insanity, the cytoly- 
sis or disintegration of the cell. Clytothesis, or the rebuild- 
ing of the cell for the cure of neuropathic states, is what, 
in conditions of auto -toxicity, bacterio- toxicity and extrin- 
sic poisonings of the nerve centers. Dr. Van Giesen pro- 
poses in the therapy of insanity and other psycho- neuroses 
and in the neuropathies in general and in all such condi- 
tions so fast as they may be found out. "So say we all of 
us." 

Female Escort for Insane Women. — Since August, 
1895, the law of Connecticut has required that in every 
committal of an insane female beneficiary to the Connecti- 
cut Hospital, the probate court "shall, unless such female 
is 1o be accompanied by a member of her own family, 
direct that at least one adult female shall accompany her." 
This is an excellent legal safe-guard and should be the law 
of every state. 

University of the State of Missouri. — A bill has 
been introduced into the House and Senate giving the Uni- 
versity at Columbia an additional endowment of two mil- 
lions of dollars bearing interest at five per cent, a year. 
The general revenue fund is now not large enough to pro- 
vide for all the public institutions of the state. Hence, at 
the suggestion of Governor Stone, seconded by Governor 
Stephens, and endorsed by all the officers of state at Jef- 
ferson City, a bill has been introduced providing for the 
needs of the University by adding to its endowment two 
millions of dollars. The interest will be paid out of the 
interest fund, which is amply able to bear the expense, and 
not out of the general revenue fund, which is not now 
sufficient for the institutions of the state. We are in favor 
of the above but not the rate of interest. Long time bonds 
bearing 2yi to 3%, say fifty year bonds, could be placed and 
would be as desirable as British consols, for dependent and 
helpless and untrustworthy beings, etc. This Journal will 
favor no 5% interest in the future for state indebtedness. 
The times have changed. 

Association of Assistant Physicians of Hospi- 
tals for the Insane.— The fourth meeting of this asso- 
ciation was held December 3d and 4th, 1896, at the Eastern 
Michigan Asylum, Pontiac. 

The following papers were read; Five Cases of Hys- 



jdbyGoOglC 



250 Editorial, 

terectomy in the Insane, Dr. Isabel M, Davenport; Static 
Electricity in the Treatment of Nervous and Mental Diseases, 
Dr. H. R. Niies; Delirium Grave, Drs. A. S. Rowiey and 
Robert Howell; Bone Marrow in Anjetnia, Dr. William C. 
Mann; A Series of Cases of Erysipelas in Insanity, Dr. 
George Boody; A Classification and Table for Practical 
Use, Dr. R. M, Phelps; The Examination of the Insane, 
Dr. William G. Stearns; Pubescent and Adolescent Insanity, 
Dr. Jason Morse; Paranoia, Dr. J. H. Gahagan: Some Modern 
Agents in the Treatment of Insanity, Dr. Irwin H. Neff. 

International Medical Congress. — Section on 

Nervous and Mental Diseases. — Presidents, Profs. A. J. 
Kojewnikow, S. S. Korsakow, W. K. Roth, Moscou. 
Members of Committee, Prof. J. A. Amfimow, Kharkow; 
Prof. B. M. Bekhterew, St. Petersburg; Prof. L. O. Dark- 
chevitch, Kazan; Prof. P. J. Kovalevsky, rector Varsovie 
University; J. P. Merjeevsky, academician, St. Petersburg; 
Prof. O. O. Motchoutkovsky, St. Petersburg; Prof. J. G. 
Orchansky, Kharkow; Prof. M. N. Popow, Tomsk; Prof. 
N. M. Popow, Kazan; Prof. Runeberg, Helsingfors; Prof. 
J. A, Sikorsky, Kiew; Prof. Soeian, Helsingfors; Prof. 
W. P. Tchige, louriew; Prof. A. E. Stcherbak, Varsovie. 
Secretaries, L. S. Minor, agrege, Moscou; W. P. Serbsky, 
agrege, chief of the clinic of mental diseases, Moscou. 

Atropine Versus Quinine Tinnitus. — A writer, 
M. Aubert, in the Lyon Medicate, January ultimo, relates 
three cases of neuralgia in which he attenuated and even 
suppressed this disagreeable symptom by adding a small 
dose of atropine sulphate. From five to seven grains of 
quinine were given at a dose and to each the author added 
0.007 of a grain of atropine sulphate. In one case this 
prevented and in the two others greatly moderated this dis- 
agreeable symptom. The pains were allayed and no atro- 
pinism followed. 

A favorite formula in sciatica and facial neuralgia of 
suspected malarial origin with us for the past twenty-five 
years has been as follows: 

a Quinlae Bisulph 3 ij. 

Ent. Belladona, gr. IIJ. 

Ext. Nucis Vom gr. Jss. 

Llq. Potass. Arsen., 5 i- 

Ext. Tarax. et Olel 

Menth. Pip., q. s., ft. mass. 

Ft. Cap., No. XXIV. 

Sig.: — Two capsulfs after each meal. 
P. S.— Latterly we have added twelve grains talia-dlastase or scale 
pepsine to the above; sometimes both and a duodenal digestive. 



,db,Googlc 



Editorial. 2S1 

We think susceptible patients tolerate the quinine better 
perliaps with the atropia, but we have not discovered that 
the idiosyncracy against quinine in some persons has been 
truly overcome or that the tinnitus of the drug is entirely 
destroyed by the atropine. Hydrobromic acid or sodium 
bromide act better in this direction. 

American Medico-Psychological Association, 

— Preliminary programme of the fifty third annual meeting 
of the American Medico- Psychological Association, to be held 
at the hall of the Medical and Chirurgical Faculty, 847 N. 
Eutaw Street, Baltimore, on May 11, 12, 13 and 14, 1897, 
at 10 a. m.;— 

The President's Address, TheophilusO. Powell, Milledge- 
ville; Annual Address, The Relations of Neurology to Psy- 
chiatry, B, Sachs, New York; The Medical and Material 
Aspects of Industrial Employments for the Insane, G. Alder 
Blumer, Utica; The Constructive Forces, Ralph L. Parsons, 
Greenmont; Insanity Following Surgical Operations, Richard 
Dewey, Chicago; General Questions of Auto -Infection, 
Charles K. Clarke, Kingston; The Historical Development 
of the Conception of Auto- Intoxication, August Hoch, Wav- 
erly; The role of Auto- Infection in Melancholia and Epilepsy, 
Charles G. Hill, Baltimore; Clinical Aspects of Auto-Intox- 
ication, Arthur W. Hurd, Buffalo; Another Chapter in the 
History of the Jurisprudence of Insanity, Dartiel Clark, 
Toronto; Nursing in State Hospitals and Training of Nurses, 
Peter M. Wise, Albany; The Development of the Higher 
Brain Centers. Stewart Paton, Baltimore; The Private 
Hospital for the Insane, Carlos F. MacDonald, Pleasantville ; 
An Unusual Case of Meningitis, C. B. Burr, Flint; Com- 
mitment of the Insane, Edward N. Brush, Towson; Sporadic 
Cretinism in the Negro, Henry J. Berkley, Baltimore; 
Hospital Records, R. L. Parsons, Greenmont. 

Congres International de Hedecine Moscou, 7 
(19) — 14 (26) Aout 1897. Section des maladies Nerveuses 
et /Aentales. 

COMITE D'ORGANISATION:— Les g^rants: Prof. A. 
Kojevnikoff, Prof. S. Korsakoff, Prof. W. Roth (Moscou). 
Membres: Prof. J. Anfimow (Kharkow), Prof. W. Bech- 
terew (St. Petersbourg), Prof. L. Darkschewitz (Kazan), 
Prof. P. Kowaiewski (Varsovie), Academicien J. Mierzeiewski 
(St. Petersbourg), Prof. Motschutkowsky (St. Petersbourg), 
Prof. J. Orchanski, (Kharkow), Prof. N. Popow (Kazan), 
Prof. M. Poriow (Tomsk), Prof. Runeberg (Helsingfors), 
Prof. Selan (Helsingfors), Prof. J. Sikorski (Kiew), Prof. 



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252 Editorial. 

V. Tschisch (Juriew), Prof. Stcherback (Varsovie). Sec- 
retaires : Priv. • Doc. L. Minor (Moscou) , Priv. -Doc. W. 
W. Serbski (Moscou). 

PROGRAMME PRELIMINAIRE.— A. Maladies nerveuses. 
Thames de programme. 

1. Patliologie de la cellule nerveuse (Anatomie fine et 
lesions pathologiques). Rapport Prevu. — Prof. V, Gehuch- 
ten (Louvain): "L'anatomie fine de la cellule nerveuse." 
(Communications Annoncees,*) — Prof. Ch, Dana (New 
York) : "The Pathology of acute Alcoolism and alcoolic 
Oedem of the Brain with special Reference to Changes in 
the Nerve Cells.". Prof. Ira van Gieson (New York): 
"Normal and pathological Cytology of the Ganglion Cells." 

2. Pathogenic et anatomie pathologique de la syring- 
omyelie. Rapports Prevus. — Prof, Fr. Schuitze (Bonn) : 
"Pathogenese der Syringomyelic." Priv. -Decent Dr. H. 
Schlesinger (Wien) : "Ueber einige Kapitel aiis der Path- 
ogenese und der pathologischen Anatomie der Syringomyelic." 
Priv.-Docent L, Minor (Moskau) : "Klinische und anatom- 
ische Bcobachtungen fiber traiimatische Affectionen dcs 
Ruckenmarkcs, centrale Haematomyelie und centrale Hohl- 
enbildung." 

3. Pathogenic et traitemcnt du tabes dorsalis. Rap- 
ports Prevus.— Prof. H. Oberstciner (Wien): "Die Patho- 
genese nnd.das Wesen der Tabes." Prof. Pierret (Lyon): 
"La Pathogenic du tabes en y comprenant ses localisations 
cerebrales. Prof, W, Erb (Heidelberg): "Ucber die Ther- 
apie der Tabes." Prof. J. Grassct (Montpellier) : "Le trai- 
tement du tabes," Communications Annoncees. — Dr, 
Althaus (London) : "Pathogenesis and Treatment of Tabes." 
Prof. M. Benedikt (Wien): "Die Tlieorie der Tabes dor- 
sualis." Prof. L. Darkschewitsch (Kasan) : "Ueber die 
Natur der Ruckenmarksveranderung bei Tabes." Prof, 
Borgherini (Padoue): "Quelques observations sur I'etiolo- 
gie et la pathogenic du tabes." Prof. Eulenburg (Berlin): 
■'Ueber die Behandlung der Tabes." Prof. Benedikt 
(Wien): "Blutiee Nerwendehnung bei Tabes." Dr. Fren- 
kel (Heiden): "Behandlung der tabischen Ataxic," Dr. 
A. Raichline (Paris): Quelques considerations sur le traitc- 
ment du tabes dorsalis. Indications et contraindications." 
Dr. R. Hirschberg (Paris) 1. "Sur le tabes dorsal juv- 
enil." 2. "Sur unc forme reputee rare du tabes dorsal." 
Outre les trois themes de programme enumeres ci-dcssus. 



jdbyGoOglC 



Editorial. 253 

la question suivante, qui en fait egalement partie, sera Jis- 
cutee dans une seance, que tiendront en commun les sec- 
tions des maladies nerveuses et de chirurgie. 

4. Traitement op^ratoire des maladies du cerveau. 
Nous indiquons ci-dessous les travaux qui seront presentes 
par les adherents de notre section. Rapport Prevu. — Prof. 
■H. Oppenheim (Berlin): "Ueber die durcli Fehldiagnosen 
bedingten Misserfolge der Hirnchirurgie." Communications 
Annoncees. — Prot. B. Sachs (New York): "Surgical Treat- 
ment of Epilepsy." Dr. A. Voisin (Paris): "Un cas 
d'epilepsie Jacksonienne traite avec succ^s par la craniecf- 
omie." Communications annoncees sur d'autres themes. — 
Prof. Cesare Lombroso (Turin): "Les nouvelles formes des 
epilepsies." Prof. B. Sachs (New York) : "Hereditary 
spinal Affections." Dr. A. Haichline (Paris): "Communi- 
cation sur un suiet de neuropathologie clinique." Prof. J. 
Crocq (Bruxelles) : "Un nouveau symptome des maladies du 
cerveau." Priv.-Docent A. Korniloff (Moskau): Thema 
vorbehalten. Dr. Hoist (Riga): "Ueber die Anstaltsbe- 
handlung der Neurosen." Dr. Alex Robertson (Glasgow): 
"Some newer Methods of Treatment in Diseases of the 
Central Nervous System." 

B. Maladies mentales. Thames de programme, 

1. Obsessions et idees fixes: Rapports Prevus. — Prof. 
Pitres (Bordeaux) et Dr. Regis (Bordeaux): "La semeio- 
logie des obsessions et idees fixes." Communications An- 
noncees. — James Shaw, M. D. (Liverpool): "The Patho- 
genesis and Differenciation of Verbal Obsessions and 
Pseudohallucinations." 

2. Patliogenie de la paralysie generale des ali^nes; 
delimitation de cette maladie des formes morbides voisines. 
Rapports Prevus. — Prof. Otto Binswanger (Jena) : "Die 
Pathogenese und Abgrenzung der progressiven Paralyse der 
Irren von verwandten Formen psychischer Erkrankungen." 
Communications Annoncees. — Dr. J. Althaus (London): 
"Delimitation of general Paralysis." Prof. Homen (Hels- 
ingfors) : "Nouvelles contributions sur une singuliSre mal- 
adie de familte sous forme de demence progressive." Priv.- 
Docent W. Muratow (Moskau) : "Zur Pathogenese der 
Herderscheinungen bei der allgemeinen Paralyse der Irren." 

3. L'hypnotisme et la suggestion dans leurs rapports 
avec les maladies mentales et la medecine legale. Rapports 
Prevus. — Prof. Bernheim (Nancy) : "L'hypnotisme et 
la suggestion dans leurs rapports avec la medicine legale et 
les maladies mentales." Communications annonces. — Priv. 
Docent A. Tokarsky (Moscou) : "De I'application de I'hyp- 



jdbyGoogle 



254 Editorial. 

notisme et de ta suggestion au traitement des maladies men- 
tales." Dr. Alex. Robertson (Glasgow): "Hypnotism and 
Suggestion in their Reference to mental Diseases." Dr. Gor- 
odichze (Paris) : "La psychotherapie dans les differentes var- 
ietes du delire emotif." Communications annonceessurd'au- 
tresth^mes. — Prof. Jolly (^Berlin) : Tliemavorbehalten. Prof. 
Cesare Lombroso (Turin): "Chaque degeneration a-t-elle 
un type.'"- Dr. Morel (Gand) : Th^me reserve. Prof, 
Fuerstner (Strassburg) : Thema vorbehalten. Prof. Xavier 
Francotte (Li^ge): "Le delire generalise (Confusion men- 
tale, Verwirrtheit)." Dr. G. E. Shuttleworth (Richmond, 
England) : "Hereditary neuroses in Children." Dr. E. 
Christian (St. Maurice, Seine) : "Sur 1' hebephrenic." Prof. 
Meschede (KcBnigsberg in Pr.); "Ueber Geistesstdrung bei 
Lepra." 

En outre nous ont annonce leur participation aux dis- 
cussions sur differents themes du programme M-rs les Pro- 
fesseurs: E. V. Leyden (Berlin), S. Henschen (Upsala), 
G. Ballet (Paris), Dr. A. Voisin (Paris). 



jdbyGoOglc 



REVIEWS, BOOK HOTKES, ET(. 



THE LEADING ARTICLE In the April Monist Is on "Hegel To- Day' ' by Prof. 
Rudolf Eucken, the Dean of the old University of Jena, and portrays In vivid, 
Intelligible style the rise, heyday, and decline of Hegel's system, together 
with the Impress which It has left upon thought tor all time, and especially 
the powerful fascination which It exerts to-day upon English and American 

In the second article on "The Genesis of Social Interests," the Princeton 
psychologist, Prof. J. Mark Baldwin, analyses the relations which the Indi- 
vidual holds to society and society to the Individual, showing how the indi- 
vidual absorbs and incorporates Into his personality his environment, and 
throwing additional light upon long established facts ol the psychology of the 
ego. 

Suggestive and Important, too, is the article on "Some Points In Intra- 
crannial Physics by Dr. James Cappie, a prominent physician of Edinburgh, 
Scotland. Dr. Cappie examines the geography, or rather the physiography, 
ol the skull, and seeks to discover what influence its architectural structure 
and the consequent forced circulation of the blood may have upon mental 

The fourth article on "The Conflict of Races, Classes, and Societies" is 
by the eminent Italian sociologist Professor G. Flamingo of Rome, and will 
be found to be of the utmost interest to all classes of readers. Professor 
Flamingo goes to the bottom ol many grave social questions which are now 
crying lor solution, and he handles his subject in a masterly, yet popular 

In his essay on "The Mythology of Buddhism," the editor, Dr. Paul Cams, 
treats of the symbolism and parables by which the philosophy of Buddhism 
was brought home to the popular mind of Asia. It is an interesting study of 
comparative religion, particularly of demonologv, and is illustrated with 
many cuts ol Buddhist saints and devils. There is also a section on Budd- 
hist art with corresponding illustrations, showing how the world-view of the 
Buddhists was represented in such pictorial designs as the wheels of life. 
Unrecognized points ol contact of Buddhist demonology with Chaldean thought 
are touched upon, and the problems of evil as a (actor useful in the working 
out of good is considered. 

Finally, we have a discussion of "Mathematical Form" by Mr. A. B. 
Kempe, Fellow of (he Royal Society and Ex-President of Ihe London Mathe- 
[255] 



jdbyGoOglC 



256 Reviews, Book Notices, Etc. 

matical Society. In the Ultras CorrespomUm* and in the Book Rnitms the 
main phUosophiul and scientific literature of France, England, Germany, and 
Italy, Is analysed, affording a complete survey of contemporaneous thought 
In these departments. Single copies, 50 cents; yearly, $2.00. The Open 
Court Publishing Company, Chicago. 

La Nouvelle Iconographie de la Salp£tri£rt enire dans sa dlxl^me annie 

d'existence. Elle vient en meme temps de changer d'editeur. 

Nous venous de recevolr le premier numfiro de la dixlime -annie et 
I'examen de ce fascicule nous prouve que chez M. M. Masson et Cle, la 
partle matfrletle de cette interessante publication ne pent encore que gagner 
en perfection. Le Nu I ne comprend en effet pas molns ne 18 figures dans 
le texte et de 9 planches hors texte dont I en couleurs, 6 en phototypie et 2 
en photogravure. 

ParmI les articles contenus dans ce No nous relevons les sulvants; Un 
cas d'h^misectlon traumatlque de la moelle, par le Professeur Raymond; 
Les rapports de la station hanch«e avec la scoliose primitive des adolescents, 
par le Dr. Paul Richer; une £tude sur rAm^lle, par Henry Meunler; un 
cas d'h^mtm^lle cbez un fils de syphtUtique, par G. Gasne; applications 
medicnles, sur la mithode de Rontgen par A. Londe et Henri Melge com- 
prenant: la description d'un nouvel Interrupteur A mercure pour boblnes 
d'lnductlon, et une «ude sur les extrimlt^s d'un sex-digitaire avec 5 rad- 
lographles. 

Enlin une large part a M faite ik la partie artlstique. M. Henry Meige 
continue sa s^rie, d'etudcssur les pelntres de ta medecine par un m^moire 
sur les pedicures du XVII siecle d'apres les pelntres des Ecotes flammande 
et hollandaise. Cette etude est accoinpagn^e de 3 planches reproduisant des 
tableeux de David Tenlers et d'Andrlen Brouwer. 

La Nouvelle Inconographle de la Salp^triere a b^n^11cl6 de la glorleusft 
renommie de son illustre fondateur le professeur Charcot. Sous sa direction 
et grace i la collaboration des repr^sentants les plus autorlsjs de la science 
francaise et 6trang^re son succes ne peul que s'atlinner dans I'avenir, car 
elle ne s'addresse pas seuTement aux m^decins et chirurglens, mals encore 
aux artistes, aux historiens. aux erudits et aux criliques, en un mot i tous 
ceux qu'interessent les manifestations de la science et de I'art sous toutes 
leurs formes. 

MANUAL Of Static electricity in x-ray and therapeutic uses. 
By s. H. Monell, M. D., Founder and Chief Instructor or the Brooklyn Post- 
Graduate School of Clinical Electro-Therapeutics and Roentgen Photography; 
Fellow of the New York Academy of Medicine. 614 pages, octavo, cloth, 
gilt. Price, 15 net; postage, 35 cents. Now ready for delivery. William 
Beverley Harison, Publisher, 3 and 5 W. I8th St., New York. 

This treatise is designed to convey practical inrormatlon to the physician 
or surgeon employing static electricity in either X-ray or therapeutic uses, 
and no references to obsolete apparatus and early discoveries are Inserted. 

As a practical clinician, writer and teacher, the author Of this book tells 



jdbyGoOglC 



Reviews, Book Notices, Etc. 257 

vhal to do and hote to do it In both X-ray work and the treatment of patients. 

This manual practically covers the medical uses of the Holtz apparatus, 
and Is accordingly a necessity to every physician or surgeon who seeks inlor- 
matlon on the subject. 

Five chapters are devoted to Crookes tubes, X-ray operative methods 
and X-ray photography. These chapters are original and contain complete 
practical instruction, much of which is not in print elsewhere. 

In the therapeutic chapters the clinical indications lor different methods 
of treatment are set forth with precision and clearness. 

Certain of the chapters possess unique value In connection with static 
electro-therapeutics. The chapter on Pain discloses the exactness of known 
indications for special methods of treatment. The chapter on Morbid Mental 
States Is instructive and valuable. Rheumatoid Arthritis receives full con- 
sideration. The chapter on Writer's Cramp illustrates the author's originality 
of method in the study and treatment of this disease. 

The medical library will scarcely be complete without this book. 

CLOUSTON ON MENTAL DISEASES. New Edition. CLINICAL LEC- 
TURES ON MENTAL DISEASES. By Thomas 5. Clouston M.D., F.R.C.P.E., 
Lecturer on Mental Diseases In theUniverslty of Edinburgh. Fourth edition, 
thoroughly revised. Octavo, 736 pages, 15 full page plates. Cloth (4. 75.' 
With Folsom's Laws of the United States on the Custody of the Insane 
($1.50.) (5.50 tor the two works. 

The wide dissemination of Mental Diseases, and the greatly increased 
difficulty ol treating them successfully In advanced stages, render It advis- 
able for every practitioner to inform himself concerning their first manifesta- 
tions and appropriate measures for their cure or control. The recognition of 
these facts is 'perhaps the cause of the demand for four editions of Dr. 
Clouston's authoritative work. He has skillfully chosen the form of lec- 
tures to secure the facility which a narrative style affords In the vivid 
picturing of this especial class of diseases, but each lecture is arranged on 
a systematic plan, opening with an exceedingly Instructive resume of the 
special subject and foUowiug with the detailed description of the clinical 
picture, the characteristics, varieties, treatment and prognosis. Typical 
illustrative cases are aptly Introduced. This edition is enriched with 
fifteen instructive full page plates. In connection with Folsom's "Laws of 
the United States on Custody of the Insane," prepared to accompany it, 
CloustoA's "Mental Diseases" wilt furnish the American practitioner all 
needed assistance in the care of his curable cases and the disposal of the 

MERRELL'S DIGEST OF MATERIA MEDICA AND PHARMACY Is a very 

concise, practical and valuable work for a ready reference treatise on the 
subject, for physicians, druggists and students. It gives full prominence, 
especially to those Indiginous nervines and other agencies, extensively 
employed and In some instances first brought into practical bedside use by 
the school of medicine in which the author ttegan practice, the Eclectic. The 
author. Dr. Albert Merreli, was professor of Materia Medica, Pharmacy 



jdbyGoOglC 



258 Reviews, Book Notices, Etc. 

and Toxicology in the American Medical College o( St. Louis and member of 
the State Board of Health of Missouri at the lime the book was first pub- 
Ished In 13S3. II is a goad ready reference book for those for whom it 
was desiensd. P. Blakiston, Son St Co. are the publishers. 

DISEASES OF THE EAR, NOSE AND THROAT AND THEIft ACCESSORY 

Cavities, a condensed Text-book. By Seth Scott Bishop, M. D,, LL.D., 
Professor in the Chicago Post -Graduate Medical School and Hospital; Sur- 
geon 10 the Illinois Charitable Eye and Ear Infirmary, etc. Illustrated with 
100 Colored Lithographs and 16S additional illustrations. One volume, 
royal octavo, pages xvi— 496. Extra Cloth, $4.00, net; Sheep or Half- 
Russia. fS.OO, net. The F. A. Davis Co., Publishers, 1914 and 1916 
Cherry Street, Philadelphia; 117 W. Forty Second Street, New Yoik; 9 
Lakeside Building, Chicago. 

A good book by a good writer. 

Clinical lessons on nervous diseases. By Dr. S. Weir Mitchell. 
Lea Brothers & Co. send us this entertaining and instructive brochure. The 
well-known name ol Its distinguished author and the ability of his clinical 
collaborators, Drs. Taylor, Burr, Hinsdale, J. K. Mitchell, Rhein, Pearcel 
Eshner and Tally, lully commend it to the student of neurological phenomena 
without further comment. 

INEBRIETY— ITS SOURCE, PREVENTION AND CURE. By Charles Follen 
Palmer, published by the Fleming H. Revill Company, 1897, New York, 
Chicago, and Toronto. 

Two Cases Bearing Upon the Diagnosis Between Ruptured Tubal Preg- 
nancy and Ruptured Pus Tube. By M. Rosenwasser, A. M., M. D.. Pro- 
fessor ot Diseases of Women In the Cleveland College of Physicians and 
Surgeons; Fellow of the American Association of Obstetricians and Gynaec- 
ologists, etc., Cleveland, Ohio. 

Physical and Natural Therapeutics. By Georges Hayem, M. D.. Profes- 
sor ol Clinical Medicine in the Faculty of Medicine ol Paris. Edited by 
Hobart Amory Hare, M. D. , Professor of Therapeutics and Materia Medica 
In the Jefferson Medical CoHege of Philadelphia. Lea Brothers & Co. , Phil- 
adelphia, Publishers. 

The Voice of the People versuf The State Board of Health of JHissourl. 
This document is well worth the considerate attention of the profession, the 
public, the Executive and the people of the slate. It Is from the pen of an 
unknown layman. The subject deserves even more careful treatment. 

Report ol a Case ol Gastrostomy, Read Before Ihe Kentucky State Med- 
ical Society, 1896. By Martin F. Coomes, A. M., M. D. Professor of Phy- 
siology, and Clinical Lecturer on Ophthalmology and Laryngology in the 
Kentucky School ol Medicine. Louisville, Ky. 

From Demoniacal Possession to Insanity. Review and Abstract of the 
Above Chapter from Andrew D. White's Warfare ol Science with Theology, 



jdbyGoOglC 



Reviews, Book Notices, Etc. 259 

By Warren L. Babcock, M. D., Second Assistant Physician, St. Lawrence 
sute Hospiui, O^densburg N. Y. 

Diseases of the Rectua as a Cause of Auto- Infection, with Report of 
Cases. By i. R. Pennington, M. D., Professor of Diseases ol the Rectum 
and the Principles of Gynecology In the Jenner Medical College, etc., Chi- 
cago. 

The Professional and Technical Schools, Especially those of Medicine, In 
their Relation to the College Course. By J. T. Eskrldge, M.D., Neurologist 
to Arapahoe County and St. Luke's Hospitals, Denver, Colo. 

Catching Cold— Its Cause and Prevention. By Fayette C. Ewing, M.D., 
Late Senior CllnlCBl Assistant, Central (London) Throat, Nose and Ear Hos- 
pital, and at the London Throat Hospital, etc.. St. Louis. 

Surgical Clinic at St. Mary's Hospital, Detroit, September 23rd, 1896. 
By H. O. Walker, M. D., Professor of Rectal Surgery, Gen ito- Urinary Dis- 
eases, and Clinical Sui^ery, Detroit College of Medicine. 

D'un Falsceau Special de la Zone Lat^rale de la Moelle Eplnlftre. Par 
le Dr. Alexandre Bruce, Midecln assistant de I'Hopltal Royal. Confirencler 
de pathologle au Surgeon's Hall d'Edimbouin (Ecosse). 

Moutb-Breathing Caused by Adenoids and Its Relief. By Hanau W. 
Loeb, A.M., M.D. , Professor of Diseases of the Nose and Throat fn tlie 
Marlon Sims College of Medicine, etc., etc., St. Louis. 

The Palliative Treatment of Hernia. By Jacob Gelger, H. D., Professor 
of Principles and Practice and Clinical Surgery In the Ensworth Medical Col- 
lege and HosplUI, SI. Joseph, Mo., etc. 

Detachment of the Retina; Sarcoma of the Choroid; SympatlMtIc Phe- 
nomena; Enucleation. By William B. Meany, M. D., Member of the Amer- 
ican Medical Association, etc., St. Louis. 

Hysteria In a Man; Tumor of the Brain; Locomotor Ataxia and Demen- 
tia Paralytica. By Hugh T. Patrick, M. D., Professor of Neurology In the 
Chicago Polyclinic, etc., Chicago. 

The Relation of Visceral Disorders to the {>e1uslons of the Insane. By 
W. P. Manton, M. D., Gynecologist to Harper Hospital and the Eastern 
Michigan Asylum for the insane. 

De I'actlon du Streptocoque et de ses Toxines sur les Nerfs, les Gan- 
glions Spinaux et la Moelle Epinlere, par M. le professeur E.-A. Homen, 
d'Helslngfors (Finlande). 

Hypnotism and Its Application to Practical Medicine. By Otto George 
Wetherstrand, M. D.. translated by Henrlck G. Petersen. M. D. Published 
by Putnam's Sons. 

The Ideal Medical Society. By Marcus Rosenwasser, M. D., Professor 
of Diseases of Women in the Cleveland College of Physicians and Surgeons, 
Cleveland, O. 



jdbyGoOglC 



260 Reviews, Book Notices, Etc. 

A Few paragraphs on ASoclions of the Lachrymal Apparatas. By Wil- 
liam B. Meany, M. D., Member of the American Medical Association, etc., 
St Louis. 

Reseotion of Arteries and Veins Injured in Continuity— End -to- End Sut- 
ure; ExperimenUl and Clinical Research. By J. B. Murphy, M. D., Clil- 
cago. 

A Contribution to the Clinical History of Non-Suppuratlve Acuta 
(Haemorrlutgic) Encephalitis. By James J. Putnam, M. D., Boston, Mass. 

Bubonic Plague— Malignant Polyadenitis. By Walter Wynan, A. M.. 
M. D., Surgeon-General, U. S. Marine -Hospital Service, Washington, D. C. 

Simulation of Nervous Disorders Following Accidents. By Pearce 
Bailey, M.O., Consulting Neurologist to St. Luke's HoplUI, etc.. New York. 

Results of (Chemical) Electrolysis Versus Divulslon or Cutting In the 
Treatment of Urethral Strictures. By Robert Newman, M. D., New Yorlc. 

The Pathology of the Blood In the Insane. By Wm.H. Harrison, A. M., 
M. D.. Ph. D.. Pathologist of the State Lunatic Hospital, Harrisbure, Pa. 

Intrabronchlal Medication. By Joseph Mulr, M. D., Physician to the 
Lung Department of the New York Throat and Nose Hospital, New York. 

Report of a Case of Acromegaly Combined with Giantism. By James 
W. Walker, M. D.. Illinois Eastern Hospital for the insane, Kankakee. 

Mental Automatism in Epilepsy: A Psychological Study. By L. Pierce 
Clark, M. D., First Assistant Physldan at Craig Colony, Sonyea, N. Y. 

Has the Physician Ever the Right to Terminate LUe? By Clark Bell, 
Esq.. LL. D., President Medico-Legal Congress, New York City. 

A Substitute for Iodoform. By Henry Hunt Duke, M. D., Instructor in 
Gentto- Urinary Diseases and Dermatology, etc., Louisville, Ky. 

Anesthesia of the Trunk in Locomotor Ataxia. By Hugh T. Patrick, 
M. D., Professor of Neurology in the Chicago Polyclinic, etc. 

Fifteenth Annual Report of the State Hospital for the Insane, at Warren, 
Pennsylvania, for the Year Ending November 30, 1896. 

Hypnotism in General Medicine. A Few Suggestions from Pereonal 
Experience. By J. T. Eskrldge, M.D., Denver, Colo. 

Notes on Some of the Newer Remedies Used In Diseases of the Skin. 
By L. Duncan Bulkley, A.M., M.D., New York. 

Re-lnfecllon In Consumption. By Joseph Mulr. M. D., Senior Physician 
to the New York Throat and Lung Hospital, New York. 

Public Health Service in the UnlUs SUtes. By Walter Wyman, A.M., 
M.D., Surgeon -General U. S. Marine Hospital Service. 



jdbyGoOglC 



Reviews, Book Notices, Etc. 261 

Congenital Ptosis— The Operarion devised by Panas for Relief Modified. 
By M. F. Coones, A. M., M. D., Louisville, Ky. 

A Further Contribution to the Study of the Family Form ol Spastic Par- 
aplegia. By Leo Newmark, M. D., San Francisco. 

I Llmlti Delia Psicologla. Estratto dal Discorso Inaugurate dell' Anno 
Accademko 1896-97 tenuto dal prof. Eugenio Tanzl. 

BralthwalCes' Retrospect of Medicine. Vol, cxlv, January, 1897. By 
Putnam's Sons, In book tonn, bound In cloth. 

The Modem Treatment of Tuberculosis, Including Specific and Organic 
Medication. By Paul Paquln, M. D., St. Louis. 

Report of Three Cases of Uterine Fibroids Complicated by Pregnancy. 
By M. Rosenwasser, M. D., Cleveland, O. 

Personally C^served Hypnotic Phenomena; and What Is f^ypnotism? 
By Dr. J. Milne Bramwell. 

Modern Method of Treatment of Diseases of the Intestines. By Fenton 
B. Turck, M.D., Chicago. 

The Legal Aspect of the Maybrick Case. By Clark Bell, Esq., of the 
New York Bar. 

How Long Is Syphilis Contagious? By C. Travis Drennen, M.D.. Hot 
Springs, Ark. 

Our Need of Philosophy: An Appeal. to the American People. By Dr. 
Paul Carus. 



On the Evolution of Hypnotic Theory. By Dr. J. Milne Bramwell. 
Hypnotic Anaesthesia. By J. Milne Bramwell, M. D. 



jdbyGoOglc 



,db,GoogIc 



THE 

Alienist and Neurologist. 



ST. LOUIS, JULY, 1897. 



ORIGINAL CONTRIBUTIONS. 



NEUROLOGICAL PROGRESS IN 
AMERICA.-" 



By C. H. HUGHES, M. D., St. Louis. 

A MERICA has contributed much to the creation of modern 
^* Neurology, especially to Neuriatry or Clinical Neurology. 
By the term Neurology I include normal neurology, and ab- 
normal neurology, which I t^rm Neuriatry, and Psychology 
and its opposite morbid aspects, psychiatry. In this great 
historic city one of its most honored names in medical and 
political history, Dr. Benjamin Rush, was the pioneer psy- 
chiatrist and neuriatristt (if you will permit the coinage of 
this word) of the century. The consideration of mental 
aberration received much attention at his hands. It was here 
that insanity first had a hospital set apart to its victims, 
and inehriety was treated as a disease under the name 
of Oinomania. This great physician and statesman made a 
study of Alcoholism, its causes and consequences, and boldly 



jdbyGoOglC 



264 C. H. Hughes. 

proclaimed it the drink disease in advance of all the world, 
just as Ephriam McDowell, in Kentucky, had boldly cut into 
the abdominal cavity and made the first successful laparoto- 
mies, thus opening the way to the greatest of the present 
life-saving triumphs of modern surgery. So Rush opened the 
way here as he did for that great declaration of principles 
which made this a free, independent and invincible nation. 

No record of American medical progress, no tribute to 
American medical glory is complete without Pennsylvania, 
and no literary monument commemorative of the profession's 
grandeur and honor could stand whose pedestal is not placed 
in this city of medical greatness and brotherly love. He 
not only took a seat in the Continental Congress and made 
a preliminary draft of and signed the final Declaration of 
Independence, but he laid the foundation, with his eminent 
colleagues, broad and deep for the first, and still living and 
vigorous, American medical college. But he did more in 
Neuriatry than I have mentioned. He recognized the neuro- 
pathic diathesis which he called the "phrenitic predisposi- 
tion, a union of diffusive morbid irritability involving the 
nerves and that part of the brain which is the seat of the 
mind," and he notes the disposition and capacity of certain 
lunatics to simulate sanity for a purpose. He also notes 
how the incipient delusions of the insane are mistaken for 
the cause and relates a case of delusional mental infidelity 
in a woman ; "of great tnedico'legal significance" {op. cit. p. 44). 
He recognized and named a phase of affective or moral 
insanity before the term had been invented in what he 
called the "lieing disease." 

Rush's definition of illusion, "a waking dream," is the 



Th™Mno.«nn.i«l. 


Is ( »urc« of profciilonal phdi (o note (he historic Iscl as ■ 


"iBcmbtrol ih« pravlUaniil col 


Kcrcnce ol PennsylvanU ind chalrnan of the connltlH lo 




uesUon whelfaer II had become expedtenl for conereis to de- 


<!>» tndcpcndfiKf, " ht nud« 


■ "report which wis adoKed and senlto the contreti the 


uncdiv'' ThljwM-'«mo»l 


■nrmaiiiiB documeni, most probably wtmcn by Ruth, as ht 






01 hllXMlf «^i Col. JiiiHs Snl 


Ih, and Included "all that ha* been to much praised la the 


Dcclarxion" (ullribulccl la Thi 


imasJeRerson.) "ol which 11 nlRhl appear lo have been Ihe 


protocol-' (Slone'i Eminem Am 


ieilcanPhyilclaniandSurE*on>.pan4JT). Rush alio went 




knowint he was to vote lor IndtptndeKe, tor he w» elected 


WHIJa v>«ncycrMl«<lbyih( 





,db,Googlc 



Neurological Progress in America. 265 

briefest on record and his amplification of it, as "a false 
perception, in the waking state, from a morbid affection of 
the brain," is perhaps the best on record. His presenta- 
tions of the morbid aspects of Icve, grief, joy, fear, anger, 
reverie, the moral faculties, and, in fact, of all the passions 
and of the morbid state of the sexual appetite, are unique 
and advanced for his day; described in 1793 a sexual per- 
vert who answered the doctor's question as to desire and 
excess thus: " Dixit per annos tres, quinque vices, se coitum 
fecisse in horis viginti guatuor, et semper semine injecto," 
antedating the records of Arnold, Kral¥t-Ebing and others on 
this subject.* 

He was familiar with sexual tabes dorsalis, hypochon- 
driasis, etc., and from 1804 to 1807 records four cases of 
madness due to onanism. He took the psycho -somatic view 
of insanity, such as the best alienists hold to-day, saying 
that, "did cases of madness reside exclusively in the mind, 
a sound state of the brain ought to occur after nearly every 
death from that disease," whereas he knew of "but two 
instances upon record of the brain being found free from 
morbid appearances in persons who have died of madness." 

Here is sound modern psycho-pathology and a correct 
psycho- somatic conception of the nature and definition of 
insanity such as we hold to-day. He denied that insanity 
was "an ideal disease" and asserted that "epilepsy was a 
bodily affection." 

He had a correct conception of Aphasia as a brain 
trouble though he neither knew its precise seat or its name 
as we call it to-day. Although he believed too much in 
venesection, as we believe too little, his therapeutics for 
acute violent mania, viz., venesection, solitude, seclusion and 
rest, acts of justice and a strict regard for truth, "everything 
necessary to their comfort and every promise made to them 
faithfully performed," is good fin de ciecle psycho-ther- 
apy, except that we have therapeutic substitutes for blood- 
letting not known to this archiater in psychological medi- 
cine. He was the American pioneer in the modern manage- 

*VUi p. 348. DIhiis« ti Ibe Mind. Phlladclphl*. 1812. 



jdbyGoOglC 



266 C. H. Hughes. 

ment and treatment of the insane and the world's pioneer 
in correctly understanding and providing for the inebriate 
as a brain-damaged man. He was the world's champion of 
the morbid inebriate's rights and demanded for him, hos- 
pitals for treatment like other sick persons. "They are as 
much objects of public humanity and charity as other 
people," he said (vide op cU. p. 267). He invented the 
tranquilizing chair as a more humane substitute for the 
straight jacket, and his law of kindness with his patients is 
now the modern rule of action in all hospitals for the insane. 
Rush's record might be further extended, but enough has 
been said to name him among the immortals in medicine and 
philanthropy as he is among statesmen. His name was not 
born to die whether Congress adorns or neglects to honor 
Washington with his statue. 

Surely the profession of America and especially of this 
great city should be proud of having had in its ranks this 
far seeing philanthropic physician. 

Before leaving this subject, we here note the fact in 
parenthesis that Robley Dunglison, also a Philadelphian, in 
earlier editions of his classic Medical Dictionary, has informed 
us that such a nervous condition as nervous debility existed 
and even gave us the name Neurasthenia with the long ac- 
cent on the i. 

The first systematic treatise devoted exclusively to the 
medical Jurisprudence of Insanity in any language was writ- 
ten by the friend and the benefactor of my youth, Doctor 
Isaac Ray, of Philadelphia, a work still recognized as high 
authority in American and foreign courts. Kay's exposition 
of the clinical features of insanity are clear and concise. 
His delineations of its affective forms have never been sur- 
passed, while his pleas for justice to the insane have been 
so masterly and forceful as to markedly modify the practice 
of American courts in the direction of greater humanity and 
justice to the mentally maimed than prevailed before his 
day. He so amplified and emphasized the definition of 
Andrew Combe, "A prolonged departure without adequate 
external cause from the natural modes of thought, feeling 
and action of the individual," as to make it plain and 



jdbyGoOglC 



Neurologicat_ Progress in America. 267 

effective in many celebrated cases of lunacy inquiry before 
American courts and juries. His clear cut description of 
morbid mental character as sliown in tlie Parisli and Angell 
will cases, the Hinctiman and Bernard Gangly cases, and 
the trials of Rogers and Winnemore, won him undying for- 
ensic fame as a faultless psychiater in court, while his 
analysis of Shakespeare's delineations, his illustration of the 
insanity of distinguished writers and of King George, the 
Third; in short, every chapter in his contributions to men- 
tal pathology, prove him to have been the peer in power 
of psychological analysis of the mind diseased, of any alienist 
of his day. His treatise on mental hygiene for youth fur- 
ther confirms this high opinion, and J had opportunity in 
his later lifetime to personalty observe his clinical ability as 
a very Corypheus in practical psychiatry as I, as a guest, 
walked the corridors of Butler Hospital with him while he 
filled the place of my friend. Dr. Sawyer, of Butler Hospi- 
tal, then absent in Europe. Both are jewels in psychiatry's 
crown. Ray was the author of "The Propositions," a set of 
rules and regulations for the government of hospitals for the 
insane, which, like his little treatise on the good superin- 
tendent and the good attendant, were never equaled before 
and have not been surpassed since. 

Since Ray, Gait, Stearn5,Awl and Gray, Godding, Spitzka, 
Hammond, JMcLane Hamilton, Fisher, Webber and Folsom 
have made valuable contributions, also Storer and Mann, and 
I myself have added a few monographs, but none have sur- 
passed or even equaled the great leader whose mortal 
remains lie buried in Greenwood, while immortal memories 
stretching over the world of psycliological science, center at 
his tomb. 

Before passing on J stop to note the most philosophic 
treatise on pseudopia since "Dendy's Philosophy of Mys- 
tery" or "Brierre de Boismont's Hallucinations" appeared, 
and far more scientific, namely, "Visions: A Study of False 
Sight" Ipseudopia), by Edward H. Clarke, M. D., of Bos- 
ton, written, like the memoirs of General Grant, Napoleon 
and Thomas H. Benton, white fighting malignancy marching 
remorselessly and resistlessty to inevitable victory, tn this 



jdbyGoOglC 



268 C. H. Hughes. 

little book, written in 1877 and dedicated to Dr. Oliver 
Wendell Holmes, the author's anatomical, physiological and 
pathological basis of cerebral visions still holds to a very 
considerable extent with the profession and though not 
wholly novel at the time, no work up to that date, with 
which I am familiar, had so fully or so clearly presented the 
subject. 

We go back now to an earlier date to find in neuro- 
. logical annals the distinguished name of Dr. Amariah Brigham, 
first of Vermont, later and finally of New York, and his two 
treatises, the one on "Mental Cultivation and Excitement" 
in 184S, the other on "The Brain and Nerves", show how 
early and forcibly American attention was drawn to neurology 
as a proper and imperative study. In an inquiry of two hundred 
and twenty-seven pages, "Concerning the Diseases and 
Functions of the Brain, Spinal Cord and Nerves," published 
by George Adlard, New York, in 1840, by this author, is 
contained a great many valuable clinical contributions to 
psychiatry and neurology, which have not been duly credited 
to him. He was the first Alienist to look upon masturbation 
in certain cases as the result and not the cause of insanity, 
contrary to Rush. 

The power of expectant attention and self introversion 
is most intelligently presented by him under the head of 
"Effects of Mental Attention on Bodily Organs," giving 
clinical illustrations of dyspepsia, melancholia and fever 
thus induced and of cures effected. His original view of 
dyspepsia as a nervous breakdown, 1 believe to be the most 
tenable view of the subject in the face of extensive clinical 
observation, as 1 have elsewhere noted.* He noted cases of 
hysteria in the male and elucidated the subject, as well as of 
chorea, tetanus, hypochondriasis, delirium tremens, etc. His 
conceptions of the nature and causes of neuralgia were 
nearly up to the present date. He understood epilepsy about 
as well as we do to-day and enjoined that "the brain and 
nervous system of those who die of epilepsy should be 
examined with great care, and whenever opportunity presents 

*fidt Addrcii on Medicine. Amciicin Medlcil Astocldlon, >t San FnnclKo. 1B94. 



jdbyGoOglC 



Neuroio£ical Progress in America. 269 

shouiti be compared with those who have never been 
affected with that disease." He had advanced 
knowledge respecting the relationship of the vagus nerve 
and sympathetic systems. Discussing a case of suicide In 
a case of recurrent delusional insanity, which, on post-mor^ 
tern examination, showed "upon the nervus vagus, 
pneumogastric nerve, of the left side, just before the recur^ 
rent is given off, a fixed, hard jaggy body about the size ol 
a kidney bean or small wart composed of calcareous matter, 
he says: "When we consider that the nervus vagus rises 
in the medulla oblongata, but is chiefly distributed to the 
great organs not under our control, and that it communicates 
with almost the whole of the ganglionic nerves, we may 
form some idea of the irritation and disturbance produced 
in the digestive, sanguiferous and sanguific organs by a 
jagged, calcareous mass implanted, as it were, into one of 
the most important nerves of the great vital vicera!"* 
How like a modern neurologist he speaksl But hear him 
further. Concluding an article on the great sympathetic 
nerve and diseases and autopsic morbid appearances con- 
nected therewith, with regret at the paucity of knowledge 
of its functions, he says: "We know * * * enough to con- 
vince us that they (its functions) are important" and "we 
can not but lament its condition is so little regarded in dis- 
ease and in post-mortem examination. "t Tilt could talk no 
better. He discusses focal lesions of the brain and of all of 
the cranial nerves in a most intelligent manner for his time; 
gives a case of traumatic aphasia without, of course, 
having a name for it, and a case of bullet wound 
of the corpus collosum, from Hennan, with apparent 
recovery but subsequent death from a bout of drinking with 
the wounded soldier's comrades. But we cannot follow this 
interesting American pioneer in neurology further. From 
what we have thus far taken from this author we are well 
prepared for such up-to-date expressions as appear in the 
preface to Brigham on the Brain, notwithstanding they were 



jdbyGoOglc 



270 C. H. Hughes. 

spoken fifty-seven years ago: "The study of the human 
brain yields in utility and dignity to no other. It is the 
study of the most important part of the organism, of that 
portion for which all the others seem to be created. It is 
of the highest philosophical interest from the connection of 
the nervous system with the manifestation of mental phe- 
nomena. From the general diffusion of this system and its 
knflwn uses we should expect it to have great influence in 
disease and that, as intelligence and mental cultivation, the 
excitement of the feelings and passions, all of which affect 
this system, increase, that an increase of nervous diseases 
and new affections of this system should be observed." And 
this we find to be true. Apoplexy, palsy, inflammation of 
the brain, dropsy of the head, insanity, etc., are far more 
common now than in past ages and are most observed in 
countries where there is the most mental excitement. We 
also now witness forms of nervous diseases or affections of 
the brain and nerves that were nearly unknown half a cen- 
tury since. Enjoining a more accurate knowledge of the 
anatomy of the brain and its connections, he regrets that 
"generally diseases of the nervous system are not thus 
investigated," and complains that "attempts to elucidate 
the diseases of the spinal marrow by autopsical examination 
are quite rare and those of the ganglionic system still more 
so." "Every one knows," he continues, "that certain 
symptoms indicate disease of the brain, or its membranes, 
or nerves; but until quite recently, and now almost gen- 
erally, physicians rest satisfied with merely knowing that 
disease is located somewhere in the skull, but we should cer- 
tainly strive to know more than this. * * * Few physicians 
are satisfied with merely knowing that a patient has some 
disease within the abdomen or thorax; they seek to know 
what particular organ is affected and what tissue or portion 
of the organ is diseased. * * ■'' We have but to pursue the 
same course as regards diseases of the nervous system," 
etc. "This field of investigation is indeed very great and 
will require for a long time many laborers, but ultimately, 
I apprehend, will richly reward those who cultivate it." 



jdbyGoOglC 



Neurological Progress in America. 271 

The object of his work, he tells his readers in his 
preface, "is to call attention of practitioners of medicine to 
the importance of the nervous system; and to persuade 
them to embrace every opportunity to study its functions 
and diseases," which have "vastly increased with the 
increase of civilization and now constitute a far greater 
proportion of the diseases of mankind than in past ages and 
consecpiently demand far more attention." 

Here was the neurological pathfinder who blazed the 
way through the unknown forests of Neuriatry for an army 
with torches and banners whose bright lights have since 
illumined the world. By these early lights we now see why 
it is that American Neurology has so many brilliant and 
sturdy devotees and contributors, like its emblematic statue 
of Liberty, to enlighten the world. If nervousness is, as 
our neurologic cousins across the water assert, the American 
disease, it had American discoverers, and the name of George 
M. Beard is immortal as a later pathhnder in neurology and 
neuriatry. His untimely death was indeed a great loss to 
the world and that part of the world's work in which we 
delve. 

His treatise supplemental to "Neurasthenia" entitled 
"American Nervousness," and the "Scientific Basis of Delu- 
sions" and other contributions which go to make up the 
pedestal of his fame, are noted in the bibliography of this 
paper. 

M. Gonzalez Echeverria, whose work on epilepsy with 
anatomico-pathological notes, original plates and engravings, 
first appeared in 1870, had about as thorough a clinical 
knowledge of epilepsia as any writer of his time, and basing 
his views on clinical observation and the experiments of 
Kussmaul and Tenner, "that sudderk arterial anaemia of the 
brain, as also Faradization of the cervical sympathetic nerves 
which determines permanent spasms of the blood-vessels, 
gives rise to epilepsy", -he maintained that epileptic con- 
vulsions are likewise induced, as well as "when the blood 
rapidly assumes a venous character." 

Kussmaul and Tenner's experiments, in addition to 
those of other physiologists, establish the chief share which 



jdbyGoOglC 



272 C. H. Hughes. 

the sympathetic has on the determination of spasms and 
confirm Brown-Sequard and Vander Kolk, and E. main- 
tained that the "seat of epilepsy," the nodus epiUpiiais, "is 
in the medulla oblongata, with a material modification in 
every case." The over excited action of the "ganglionic 
cells of the medulla controlling the vasomotor elements and 
nutrition," were to him the seat and cause, the invariable 
and necessary element, of the epileptic paroxysm which he 
says, "may well occur without muscular spasms." Not- 
withstanding the exception taken by Vander Kolk to 
Echeverria, "cerebral anaemia is among the very initial 
phenomena of the epileptic paroxysm." 

Though the exclusive medulla oblongata locui origo 
epiUpticus is not now tenable and cortex or Jacksonian 
epilepsy is a proven fact, yet the vaso-motor spasm view 
of this author has not yet been overthrown and his "Dis- 
cussion of the Modern Doctrines of Epilepsy" is still critical 
and classical in the light of further and later discovery. 

Next upon the scene appear in paths to American Neu- 
rological glory William A Hammond, Weir Mitchell, H. C. 
Wood, Seguin, E. C. Spitzka, McLane Hamilton, James G. 
Kiernan, Chas. K. Mills, J. J. Putnam, Isaac Ott, Charles L. 
Dana, R. W. Amidon, M. Allen Starr, J. K. Eskridge, S. V. 
Clevenger, B, Sachs, Daniel R. Brower, Harold N. Moyer, 
Frederick N. Peterson, William Fuller and a host of others 
whose names may come to us as we proceed and their work 
appear in the supplement to this paper and in the future 
historian's pantheon of America's neurologic gods. 

Hammond, by his indefatigable zeal and captivating 
style of writing, gave an impetus to neurological medicine 
whose wave is still felt in the profession. In 1867, shortly 
after his retirement from the Surgeon Generalship of the 
United States Army, he founded and for many years, main- 
tained the Journal of PsvcHohgical Medicine and Medical Jut' 
isprudence, a high grade quarterly periodical which was 
promptly accorded, and always held, front rank in the lit- 
erature of neurology. 

In the second volume, the dynaraoneter and dynamo- 
graph are for the first time, in this country at least, illus- 



jdbyGoOglC 



Weurohgical Progress in America. 273 

trated and elaborately described by Dr. H. In this volume, 
Hammond maintains that chlorosis is a disease of the ner- 
vous system. In this volume also appears a unique pre- 
sentation of the subject of Carnomania by Charles F. Tay- 
lor; the Microscopical Appearance of the Brain and Spinal 
Cord, by J. G. Webber, of Boston; Historical Considerations 
Concerning the Properties of the Roots of the Spinal Nerves, 
by Austin Flint, Jr.; Roberts Bartholow, then of Cincin- 
nati, and E. C. SeKuin have separate articles on Aphasia; 
T. Edwards Clark handles the subject of Animal Mag- 
netism; Hammond, The State of the Mind During Sleep; 
Organic Infantile Paralysis, S. Henry Dickson; The Legal 
Consequences of Insanity, Horatio R. Storer; The Law of 
Rape, Suicide and Insanity, by T. Edwards Clark; Ham- 
mond, Epilepsy Due to Cerebral Ansmia; Nathan Allen, of 
Lowell, The Law of Human Increase, or Population Based 
on Physiology and Psychology; Statistics of Opium Poison- 
ing by Alonzo Calkins, of New York ; An Improved Pocket 
Aesthesiometer, by Hammond, besides an interesting chron- 
icle in each number of the world's contributions to Psy- 
chiatry, Neuro- physiology and Neurology. This ably 
conducted and invaluable journal was continued for years. 

Hammond's classical works on Diseases of the Nervous 
System, Insanity, etc., are too familiar to the neurological 
world to require elaborate portrayal here, even if we had 
the space and you the time for the record. 

Hammond's early impress on American Neurology, as it 
is upon the literature of Medicine, is indelible. His orig- 
inal description of Athetosis alone is an addition to neuro- 
logical discovery, as are Weir Mitchell's on Erethromelalgia 
and the cremaster reflex that have stood the crucial test; 
and I think I may likewise modestly claim something (or the 
virile reflex and its clinical and medico-legal value, when it 
shall have been further studied. The difficulty of eliciting 
it is its chief obstacle to acceptance, but it is an undoubted 
clinical fact of great value in diagnostic neurology. 

Hammond inspired a host of younger men to follow his 
footsteps. In January, 1854, under his inspiration, the first 
number of the Chicago Joumat of Nervous and Mental Diseases 



jdbyGoOglC 



274 C. H. Hughes, 

was started by the lamented and talented J. S. Jewell and 
his able associate, H. M. Bannister; the first article of the* 
first volume being an original lecture on the Pathology of 
the Vaso-motor Nervous System by Jewell who had pro- 
duced the same at a lecture in the Chicago Medical College. 
These lectures were continued through this volume. The 
articles, selections and annotations were of a high order. 
This journal was temporarily suspended at the death of its 
talented and cultured senior editor, but soon revived again 
and brought out in New York where it continues to appear 
as a monthly of no mean merit under the editorial manage- 
ment of Dr. Charles Henry Brown and an able corps of 
well-known collaborators. 

In January, 1880, my own journal, the ALIENIST AND 
NEUROLOGIST, first appeared in St. Louis. It has never 
missed an issue since its first number and we continue to 
do business at the old stand and on the same principles of 
progress; regarding a proper understanding of the nervous 
system, anatomical, psychiatric and neuriatric, as the chief 
end of man in medical research and practice. 

Following this was McBride's Review of Imanity and 
Nervous Diseases, a meritorious, but now suspended, period- 
ical of the specialty. 

Antedating all of these periodicals, we must not omit 
mention of that staid and valuable old neurological periodi- 
cal, limited in its scope, however, to the psychiatrical side 
of neurological medecine, Vne Am frican Journal of Insanity, 
which, under the editorial management of Richard S. Dewey, 
of Chicago, continues the good work so well begun over 
a half century ago. In its earlier issues may be found the 
records of American clinical and forensic psychiatry of most 
of the old masters, especially of the original thirteen who 
founded the Association of Superintendents of American Hos- 
pitals for the Insane, from which has descended the present 
American Medico -psychological Association. Their names 
were: Samuel B. Woodward, of Connecticut, first president 
of the association and originator of the Hartford Retreat; 
Samuel White, of the same state, and late Professor of 
Obstetrics and Surgery in the Berkshire Medical Institute, 
founder in 1830 of a private institution for the insane on 
the Hudson, and president of the New York State Medical 
Society; Isaac Ray; Luther V, Bell, of New Hampshire; 



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Neurological Progress in America. 275 

Charles H. Stedman, of Massachusetts, a graduate of Yale 
and Honorary, of Harvard; John S. Butler, of Hartford; 
Amariah Brigham; Pliny Earle; Kirkbride^ William M. 
Awl, of Pennsylvania; Francis T. Stribbling, of Virginia; 
John M. Gait, of Virginia; Nehemiah Cutter, of New 
Hampshire — all men who made their mark well for the wel- 
fare of the insane and the advancement of American Alien- 
ism. 

No country ever had so enthusiastic, united and pow- 
erful a phalanx to fight for the rights of the insane. Fol- 
lowing in the footsteps of Chiarugi, Pinel, York and Tuke, 
they bravely fought the foes of psychological advance to 
overwhelming defeat and won a lasting triumph of humanity 
and science in the treatment of American insane. 

.Weir Mitchell's work is likewise too familiar to us all 
to need recalhng here. He is known out west as "rest cure 
Mitchell," and "Fat and Blood" Mitchell, though he him- 
self at the time he was so christened was as iank 
and lean as hungry Cassius. But his fame rests 
en more enduring laurels, though these were enough. His 
views of the cerebellum as a re-enforcing ganglion, first 
offered in 1869, have lately been re-affirmed by Italian 
physiologists.* Besides what I have already referred to, 
his scientific, to say nothing of his literary, work, begin-, 
ning in 1852 with an investigation into the "Various Forms 
of Uric Acid Crystals and their Alterations in Highly Acid 
Urine," and not yet ended, we hope, in his instructive 
clinical lessons of the present year, is a rich heritage of 
inestimable value to America's and the world's contributions 
to Medicine. Hysteria, Mental aberration. Sciatica, Neuralgia, 
Neuritis, Sleep Jerks, Ataxia, headaches and apparitions, 
blood pressure, double consciousness, the reflexes and too 
many other subjects to here enumerate, make up a volume 
of titles alone for the instruction of the student of neurol- 
ogy, that will perpetuate his name forever. 

The Elder John K. Mitchell, father of Weir, is claimed 
by the latter to have ante-dated Sir William Gull in the 
description of spinal arthropathies, and the present John K, 



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276 C. H. Hughes. 

Mitchell, grandson of the senior, is walking wisely in the 
footsteps of his father. His recent book, "Remote Injuries 
of Nerves," is « valuable presentation of the subject highly 
creditable to modern American Neurology. The younger 
Mitchell has added something worth considering to the 
classic work of Bowlby to the study of section and injuries 
of nerves and made valuable contributions on ascending and 
migratory neuritis and the knowledge of contusions and com- 
motions of nerves, and degeneration and regeneration thereof 
has been advanced in his recent work, "Remote Conse- 
quences of Injuries of Nerves." 

No history of Neurasthenia would be complete without 
record of the writings of my much esteemed friend. Dr. E. 
H. Van Deusen, of Kalamazoo, Michigan, whose observations 
on this subject made public in 1867, I called renewed atten- 
tion to in the initial volume of my journal, the ALIENIST 
AND NEUROLOGIST, in 1880. Or. Van Deusen was at the 
time Medical Superintendent of the Michigan Asylum for the 
Insane, and under the caption, "Observations of a Form of 
Nervous Exhaustion (Neurasthenia) Culminating in Insan- 
ity," wrote as follows: "Our observations have led us to 
think that there is a disorder of the nervous system, the 
essential character of which is well expressed by the term 
given above, and so uniform in development and progress 
that it may, with propriety, be regarded as a distinct form 
of disease." 

A reference to the article introducing the subject will 
show also the essayist's view on that subject. 

Neither would the subject of Inebriety be justly treated 
without reference to the many American contributions to its 
literature by Mason, Crothers, Wright and others. Dr. T. 
D. Crethers having contributed since 1875 over a hundred 
articles on this subject, his chief elucidations being of alco- 
holic trance states and the medico-legal aspects of inebriety. 

Alcohol and drug addiction and their psychical and phys- 
ical causes have been studied by Crothers, Mason, Mat- 
teson and many contributors for the Journal of InebrUtv, a 
quarterly periodical which has long held the uncontested field 
as the only journal of the world devoted exclusively to this 



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Neurological Progress in America. 277 

subject. While some of its editor's views have been 
regarded as too radical, others have undoubtedly been held 
as advanced. Its clinical records give it just claim to a 
prominent and permanent sharer in neurological progress. 
Valuable contributions by Gurdon W. Russell, T. L. Wright, 
Mason, Crothers and others, may lil<ewise be found in the 
earliest numbers of my own journal. Wright's Treatise on 
this subject had its inception in the earlier contributions to 
the ALIENIST AND NEUROLOGIST as Geo. T. Steven's 
later book on Eye Strain in Nervous Diseases did. In 1877 
Stevens enucleated an eye-ball and cured a case of diabetes 
and in 1888 another for epileptiform disease with diabetes. 
Both recovered.* The subject of oculo-neural reflex irrita* 
tion also first appeared in the (vide supra) ALIENIST 
AND NEUROLOGIST. 

The foundation of the American Medico 'Psychological 
Association which was begun by the original thirteen as the 
Association of American Hospitals for the Insane, with the 
organization of the American Neurological Society, was the 
beginning of the diffusion of correct conceptions of mental 
and nervous diseases and their real clinical and medico- 
l4(>al significance among the general profession and the 
people. This work has also been greatly promoted by the 
New York, Philadelphia and American Medico-legal societies, 
and sections and societies of Psychical research. The clin- 
ical lectures of E. C. Seguin gave the world new light on 
the spastic paralyses and paraplegia, the excellent work of 
Spitzka takes rank with that of Golgi and others abroad on 
the fine anatomy of the brain. While Sepilli was working 
on cerebral thermometry in Italy, Amidon and Carter Gray 
were engaged in the same work in New York, and Bert 
Wilder has overwhelmed us with an almost entire recast of 
the nomenclature of cerebral anatomy, some of which has 
been already and much more is destined to be finally, 
accepted by anatomical cerebrology.* 



jdbyGoogle 



278 C. H. Hughes. 

B. Sachs, besides his timely translations, has made 
valuable contributions to our knowledge of the cerebral 
palsies, cerebral and spinal syphilis, progressive muscular 
dystrophies, and from my own observation, 1 am inclined to 
believe he has described a hitherto undescribed form of dis- 
ease under the caption, amaurotic family idiocy. 1 have 
seen two cases within a recent period, of amaurotic idiocy 
with epilepsy. Sach's book on the "Nervous Diseases of 
Children" is a valuable addition to the literature. 

The late contributions of Wm. Fuller of Grand Rapids, 
Michigan, to the objective study of course cerebral anatomy 
by his unequaled sectional models and book of plates, as 
well as his contributions to Neuro-surgery, tapping the lat- 
eral ventricles and exploration for cerebral abscess, the 
differentiation between coma of compression and reflex ar- 
teriole spasm coma, in 1897, his enunciation of the Anemia 
theory of convulsions, his arteriole spasm theory of the 
treatment of cerebral convulsions and his cranial sections for 
certain forms of idiocy at an earlier date, certainly entitle 
him to honorable mention in any record of neurological 
progress. He also maintains that Keloid is of the nature of 
neuroma and caused by injury or disease of nerve endings, 
and he drained off the subarachnoid in a case of convulsions, 
embarrassed respiration and cerebro- spinal fever in 1880. 

In 1879 C. H. Hughes read before the Missouri 
State Medical Association a paper entitled, "A Clinical 
Inquiry Into the Significance of Absent Patellar Tendon 
Reflex," showing at that early date that the knee phe- 
nomenon was absent in many cases other than Locomotor 
Ataxia. Subsequent or simultaneous observations of others, 
including Landon Carter Gray, Bannister, Erb, Westphal and 
Tschirjeu, have confirmed the fact. The paper maintained 
that the diagnostic value of the patellar tendon reflex sign 
was rather in its having been lost in connection with other 
ataxic symptoms. Dr. Gray was the first to maintain that 
the nerves involved in the tendon reflex phenomenon belong 
to a variety not hitherto recognized, viz.: voluntary nerves 
with involuntary fibres distributed to voluntary muscles, 
while Gowers at the time objected to characterizing the 



jdbyGoOglC 



Neurological Progress in j^merica. 279 

phenomenon as peripliero -central. But it is quite probaWe 
that all voluntary muscle innervation has also latent invol- 
untary nerve fiber tracts and that the involuntary muscles 
have also latent voluntary fibers, else how are we to explain 
the phenomena of convulsions and the control of the heart 
in certain persons, as in the case of Col. Townsend who 
could at will arrest his, and the control of the ears, scrotum, 
etc., in others? 

Peripheral nerve tissue is readily reproduced. Dr. S. 
Weir Mitchell, in speaking of the pathological results of 
neuritis after injury to nerves, long ago noticed an enormous 
development of connective tissue elements, and Herdman has 
made some confirmatory observations the present year on 
nerve repair after injury. But the reproduction of brain sub- 
stance has been doubted. Al. N. Vitzov*(Bucharest)found in 
the brain of a monkey a new formation occupying the back 
part of the skull, after incision of the occipital lobes two 
years previously, which he proved to be nerve cells and 
neuroglia exactly comparable in appearance to those present 
in normal tissue. Theodore Simon, in the earlier editions of 
Virchow's "Archives" reports some cases of what he denom- 
inates additional brain growth where new formations were 
found superincumbent upon the gray matter of the_ convo- 
lutions. In these new growths the gray and white matter 
were norma! in their relations and proportions. But Dr. 
John B. Gray as early as 1875 (transactions of the New 
York Academy of Medicine) records two cases of reproduc- 
tion of brain tissue after brain injury, the length of time in 
reparation of tissue corresponding with reparation of nerves 
after injuries. The brain was some twenty days in com- 
pleting its structure and the convoKitional character of the 
surfaces was distinctly marked. 

The case of Phineas P. Gage wlio had a part of his 
left brain destroyed by a premature quarry blast in Vermont, 
and the-projection of a tamping iron through his head, Sept. 
13th, 1848, subsequently dying on a farm near San Fran- 
cisco, May 20th, 1861, is the most remarkable contribution 



jdbyGoOglC 



m C. H. Hughes. 

to the subject of brain tolerance of violence and the possi- 
bility of brain repair, on record. The iron that went through 
his head was a cylindrical bar one and one quarter inches 
in diameter, three feet seven inches in length, and weigh- 
ing thirteen and a quarter pounds. The bar tapered to a 
quarter of an inch and was chisel shaped at one end. 
It entered the brain in front ot the left lower jaw, small 
end first, and out through the anterior- superior part of the 
left parietal, destroying the anterior part of the left hemis* 
phere, thence through the corpus callosum anteriorly to the 
opposite side, extensively involving the margin of the right 
hemisphere, lacerating the anterior and middle lobes, Falx 
and the longitudinal sinus. Gage recovered by the sixty- 
second day so that he walked half a mile and by the 
seventy-third day, so that he went home thirty miles away, 
the wound being closed on the one hundred and twen- 
tieth day. This man traveled, exhibited himself and the 
bar, acted as a hostler, drove a stage coach in South 
America and worked as a farm hand, dying of epileptic con- 
vulsions after an irregular life, in which intemperance played 
a part, but without paralysis or mental impairment, nearly 
thirteen years after, that is, he had neither paralysis nor 
mental impairment in the beginning. I was told by Dr. 
Warren or Dr. Rowditch, at the Boston General Hospital, by 
whose courtesy I saw the skull and tamping iron in 1868, 
that Gage was actually intellectually a brighter man after, 
than before the accident. We all know that the skull of 
this remarkable case is now in the Warren Anatomical 
JMuseum and that the man was never lost sight of by 
American devotees of psychological and neurological science 
from the time of his remarkable recovery until head and 
history were secure in the depositories of science for the 
good of mankind. It will always be regretted that the brain 
could not have been examined microscopically. But psy- 
chiatry owes to Boston a debt of everlasting gratitude for 
what it has preserved in its archives of this case under 
such difficulties, as it likewise is indebted to the labors of 
C. E. Brown-Sequard for his contributions to the duality of 
the brain, and the bromide treatment of epilepsy, though an 



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Neurological Progress in j^merica. 281 

English surgeon timidly antedated him before he took up 
his abode in Paris, and America antedates the world on the 
subject of brain and nerve repair and on the subject of 
neuritis. Kiernan, in 1882, and myself have contributed 
something to the literature of the duality of the hemispheres 
of the brain, I saw at the same time another remarkable 
case in the Boston General Hospital, from Finley, Ohio, I 
think. It was a young man who had blown through his head 
through the parietal region a piece of gas piping about H 
of an inch in liiameter. 

Since Hammond, Allan McLane Hamilton, Landon 
Carter Gray, Wood, Dana, Ranney, Starr, Mills, Dercum 
and others, have given us treatises that compare with the best 
foreign authors. Dercum has marshalled in his treatise a 
galaxy of bright particular stars of the neurological firma- 
ment, and Chas. K- Mills has in preparation a volume which 
we predict will be unsurpassed in any language. These, 
with Fuller's "Arcliitecture of the Brain" already referred 
to, Shaw's Diagnosis, Clevenger and Morton, would seem almost 
to have amply supplied the demand for neurological literature 
without the many excellent translations. But the "Twen- 
tieth Century Practice," an international encyclopedia of 
modern medical science by leading authorities of Europe and 
America, edited by Thomas L. Stedman, M. D., New York 
City, is before us and here is what an able reviewer* says 
of one of its volumes to the credit of American Neurology: 

"Volume ten is devoted to 'Diseases of the Nervous 
System.' With the exception of Dr. Fere, of Paris, who 
furnishes articles on hysteria, epilepsy, and the spasmodic 
neuroses, the contributors to this volume are all our own 
countrymen — the international element is less in evidence 
than in th; preceding volume." 

"Dr. Joseph Collins, of New York, has a long article of 
300 pages on the important subject of diseases of the brain, 
and another on diseases of the meninges. Dr. B. Sachs, 
of New York, deals with tumors of the brain, and is san- 
guine enough to predict even far greater success in the 



jdbyGoOglc 



282 C. H. Hughes. 

diagnosis and surgical treatment of intra-craniat neoplasms 
during the next decade than has been achieved in the 
recent past. Dr. Charles L. Dana, of New York, writes 
on neurasthenia; Dr. H. T. Pershing, of Denver, on dis- 
orders of speech, and Dr. Sanger Brown, of Chicago, 
closes this volume of 859 pages with a short article on dis- 
orders of sleep." 

Treatises like those of Wilks, Ross, Maudsley, Bevan 
Lewis, Obersteiner, Hirsch, Erb, Westphal, Edinger, Mendel 
and otliers, with Charcot, Sepilli and a host of other German, 
French and Italian confreres, will ever be esteemed in 
America, but it is now plain that if cut off from them, 
American neurological medicine would not starve for neuro- 
logical nutrition in its psychic centers. 

But let us proceed. The first medico-legal differentia- 
tion between Aphasia and Aphasic Insanity in this or any 
other country, so far as 1 can discover, was made by myself 
in 1879. The first contribution on the "Simulation of 
Insanity by the Insane" was also written by myself In 
1876. In 1880 I wrote on Nitrite of Amyl in differential 
diagnosis, on reflex cardiac gangliopathy, in 1881 on con- 
sciousness in epilepsy, in 1882 on hyoscyamine and some- 
thing new on the diagnosis of neuratrophia or neurasthenia. 
I proved the vaso-motor contractile power of cephalic gal- 
vanization in 1883; maintained and established the cura- 
bility of certain hitherto hopeless types of epilepsia and 
showed that the lesion of haemophilia and malarial hema- 
turia is in the sympathetic system and have continued to 
make up to date contributions to which the reader is 
referred in the appended bibliography. While it is perhaps 
true that, 

"To observations which ourselves do make, 
We grow more partial for the observer's sake," 

and that we do not wish our work, real or fancied, for the 
weal of the world, forgotten, we must not overlook the 
fact tliat we have but meajire space here for detail record 
of any one's work, so I pass over a few dozen of my own 
contributions to further notice those of your distinguished 



jdbyGoOglC 



Neurological Progress in America. 283 

confreres in Neurology, noting some of their work in the 
context and the remaining in the appendix. 

Let us mal<e a short trip to Chicago and dwell a few 
moments with that living neurological and psychological 
encyclopoedia, James G. Kiernan. Next to Kohlhaum, he 
has thrown more light on Katatonia than any other writer 
of any country. His first contribution on this subject 
appeared in 1877. His next subject was Shakespeare's 
psychiatric characters, while his psychology and psychiatry 
of the prominent characters of history have not been exceeded 
by John C. Bucknitl or William W. Ireland. His contributions 
to the study of psychology and psychiatry of genius and 
the neurology, as contradistinguished from the neuriatry, of 
genius, have been numerous and instructive. Insanity in 
nearly all of its various forms and in many novel features 
has been described by his fountain pen of neurologic truth. 
In the appendix are classified eighty-four themes in our 
line of research bearing his name as author, from tlie ataxic 
paranoiac of genius, the trophic disturbances of insanity to 
the insanity of gout and the insanity of quinine. In 18S2 
he wrote on the duality of the cerebral hemispheres. 

The relation of insanity to crime has been instructively 
studied by Harold N. Moyer, Kiernan and others in this 
country; insanity proceeding from the colon by the 
former and by the lamented Jewell ; the Medical Jurisprudence 
of Railway Surgery and Shocl<-by Moyer, Clevenger and 
Outten;the Nervous Sequella; of Influenza, by Moyer, myself 
and others; A Rare Form of Occupation Neurosis, by Moyer; 
also paranoia, nystagmus, acromegaly, infantile chorea, neu- 
ritis with knee jerks and nystagmus, exophthalmos with 
nephritis, etc., etc. [See Appendix]. 

In an inaugural thesis before the American Neurological 
Society, entitled "A Study of Nerve Cells and Their Func- 
tions,"Clevenger appears to have anticipated the later neuron 
theory.* Fry has made some recent studies on the same subject. 
Clevenger's contributions being too numerous for detail here 
will, as already said, be referred to again in the Appendix. 



jdbyGoOglC 



284 C. H. Hughes. 

Frederick N. Peterson, in 1879, made valuable studies on 
the posterior cerebral lobes in an inaugural thesis, and has 
kept up his search for new neurological light steadily ever 
since. Among his later contributions are; his. prize essay 
on "Morbus Basedowii," the Principles of Craniometry, the 
study of muscular tremor, cataphoresis, electro-thanesia, the 
colonization of epileptics, deformities of the hard palate in 
degenerates, the new phrenology, Katatonia (with Dr. C. H. 
Langdon), chapters in Starr's Familiar Forms of Nervous 
Disease, Starr's Children's Diseases, Loomis' and Bigelow's 
Treatises, and the American Text Booli of Diseases of the 
Nervous System. 

The State Hospitals Bulletin, of New York, conducted by 
Wise, Brown and Reeves, has thrown a flood of new light 
over the pathward of our progress, Ira Van Gieson having 
made some startling revelations from the State Pathological 
Institute, of which he is director, on the relation of the 
auto-intoxications to neural diseases, which Nelson Teeter 
has followed up and elaborated on the autotoxic origin of 
epilepsy. Teeter's clinical studies in cerebral tumors and 
Courtney's, on pachymeningitis, also grace the first number 
of the first volume. 

While trephining for cerebral pressure by fluid was first 
suggested abroad by T. Clay Shaw in 1889 and performed 
by Harrison Cripps in July of that year, it was done in 
this country in the following March by Wagner, of Utica. 

In 1891 Quincke flrst performed paracentesis spinalis 
for hydrocephalus. In May, '96, Turner performed this op- 
eration for general paralysis, and in this county Dr. War- 
ren L. Babcock, inUuly of sameyear;and these bulletins con- 
tain a record of his work. Here, too, we fincl Hutchings fol- 
lowing up the discovery of Huchard on Cerebral Meiophra- 
gias with valuable researches on this condition of arterio- 
scelerosis associated with certain mental symptoms. 

In truth, these bulletins reveal a bewildering scope of 
work creditable toAmerican clinical psychiatry and neurology, 
and we cannot name all the works save in the bibliography. 
Here Somer's case of general paresis in its post mortem 
showing coincides with those of the West Riding Asylum's 



jdbyGoOglC 



Neurological Progress in America. 285 

early reports, and Babcock's moral insanity confirms the 
contentions of our own earlier days. 

Syphilitic hypochondriasis was presented in 1888 by 
Allen Mcl.ane Hamilton, and Carter Gray has lately added 
to the diagnostic signs of melancholia and intracranial syphilis, 
while Frank C. Hoyt, of St. Joseph, Mo., pathologist to State 
Lunatic Asylum No. 2, gives us post mortem light on this 
subject. 

Hugh T. Patrick, who is no more of a saint than my 
friend who dreams over the Hookah, though he hails from 
the Saintly City of Chicago, maintains that he has 
knocked out the Bryson symptom in exophthalmic goiter, 
showing by a study of forty cases that the dimin- 
ished chest expansion frequently found in Graves' disease 
is in no sense pathognomonic, but is simply an expression 
of the general myelasthenia which he maintains is always 
present in this affection. An experimental and anatomical 
study of the course and destination of Gowers' tract by this 
writer, established the tact that Gowers' antero- lateral tract 
extends as a separate bundle as high as the corpora quad- 
rtgemina and then passes in a retrograde direction to the 
middle lobe of the cerebellum. 

The intimate relation between asthenic and bulbar pa- 
ralysis and polio-myelitis, has been shown by this author 
in a recent report of a case of so-called poiiencephalitis 
superior and inferior, with microscopic demonstrations. Dr. 
Patrick's studies in trunk anaesthesia in locomotor ataxia and 
syringo-myelia reveals a novelty in symptomatology, and he 
maintains that "spinal irritation" is psychic and not located 
in the spine. 

Frank G. Lydston and Eugene S. Talbot have made 
valuable contributions to the study of the stigmata of degen- 
eration especially in criminology, including regicides, ine- 
briates and aristocratic degenerates. Records of their work 
is appended. Chicago is a good place in which to study 
criminology and degeneracy, and these gentlemen are well 
qualified for the work. 

M. Allen Starr's Atlas of the Nerve Cells, with the co- 
operation of Strong and Leaming, though published abroad. 



jdbyGoOglC 



286 C. H. Hughes. 

is highly creditable, like Fuller's plates and casts, to Amer- 
ican neurological industry, ability and ingenuity. Starr's 
work on brain surgery has been complimented by transla- 
tion into the German and French languages. His contri- 
bution to the study of tumors of the spinal cord, '95, and 
diagnosis of cerebral abscess, '97, are valuable additions to 
cerebrology and spinotogy. 

We are indebted to Daniel R. Brower, of Chicago, for a 
new surface thermometer, and many studies in medico-legal 
and traumatic insanity, electro-therapy and spinal neurosis; 
to Brower, Andrews and Hughes for separate clinical studies 
of hyoscyamine; to Brower, Clevenger, Kiernan and many 
others, for records of traumatic insanity; to Brown for the 
case of MSrk Gray (concealed insanity) and Pendergast as 
a paranoiac, and too many other records and monographs for 
our space. 

Progress in the knowledge of the localization of sensa- 
tions has been made in this country especially through the 
studies of Dr. Charles L. Dana, and the diagnosis of intra- 
cranial hemorrhage and acute softening, vertigo in temporal 
lobe lesions; apoplexy, the apopleptic pulse, the cause of 
perforating necrosis of the spinal cord, its continued sclero- 
sis, . the pathology of chorea and paralysis agitans, and 
studies in alcoholism, acromegaly and the pathological anat- 
omy of Tic Douloureux, besides his text book on nervous 
diseases now going into the fourth edition which has feat- 
ures unexcelled in any book published abroad. 

The literature of multiple neuritis, paramyo-clonus mul- 
tiplex, the neuron conception of the nervous system, chorea, 
and Raynaud's disease, have been written upon by Fry, of 
St. Louis. Bauduy has given us a book that ought to be 
revised; Bremer has added to the literature of microscopical 
blood states in disease and Shaw's Diagnostic Neurology 
and contributions to morbus Thomsenii, are valuable addi- 
tions to the literature of Neurology, and my own work 
which appears mainly in my journal, the ALIENIST AND 
NEUROLOGIST, founded in 1880, 1 offer to your critical con- 
sideration. If I have accomplished but little, it is not because 
my intentions have not been good. In addition to what 



jdbyGoOglC 



Neurological Progress in America. 2S7 

has already been cursorily referred to, 1 claim the introduc- 
tion of chloral hydrat per rectum in puerperal eclampsia, in- 
fantile convulsions and obstetric practice, besides early art- 
icles on the dual action and vicarious functions of the cere- 
bral hemispheres and lobes of the brain, aphasia, hyoscyamine 
in psychiatry, moral and other forms, and the defmition, of 
insanity. 

If we take the wings of the morning and fly to the 
uttermost parts of the earth we shall find the Neurologist 
there, so rapid has been the progress of neurology 
within the short time since it began to take tank as a med- 
ical specialty, almost- within the average life of a genera- 
tion of men. But we read and go beyond the confmes of 
our own country to be satiated with the richness of neuro- 
logical contributions. An examination of the psychiatric 
and neuriatric bibliography here appended would make one 
feel, after what we have thus far gone over, like "gnaw- 
ing a file and fleeing unto the mountains of Hepsidam" for 
rest, "where the lion roareth and the whangdoodle mourn- 
eth'* for our diversion, but we will stop awhile at the Rockies 
and here we find Pershing perched on the heights of Den- 
ver, Thombs lower down in Pueblo, and Jeremiah 'T, Esk- 
ridge, the lion of the tribe of Judah, who went out to Den- 
ver with one lung and developed a voice that has been 
heard in highest and strongest neurological notes around 
the world. He has been so active there that the festive 
bacillus tuberculosis could not find further lodgement on his 
never resting cerebral anatomy. I have before me a record 
of 103 contributions to the literature embracing every aspect 
of neurological inquiry from diagnosis, pathology, physiol- 
ogy and treatment to the neural therapy of climate. His 
articles on retro- anterograde amnesia, temporary abulic 
agraphia, symptoms of speech disturbances as aids in cer- 
ebral localization, on brain tumors and glioma, and chapters 
on insanity and feigned diseases, the latter in the Ameri- 
can System of Medical Jurisprudence, have attracted much 
attention. But the full list is close at hand and I refer you 
to it. 

Since American medical literature had its birth here and 



jdbyGoOglC 



288 C. H. Hughes. 

ifince we started OUT incursion here, it is mete that we return. 
There are neurological giants in Philadelphia whose meas- 
urements we have not yet taken. The contributions of 
James Hendrie Lloyd embrace Brain Tumors, Syringomyelia, 
Diseases of Occupations, and the Spina) Cord in Pernicious 
Anxmia. Friedreich's Ataxia has received intelligent attention 
in several valuable monographs by Chas. W, Burr, of Phil- 
adelphia, and its pathology has been especially elucidated 
by this author. Prof. Burr has also reported a case of hys- 
teria with ataxia confined to one leg, discussed the frequen- 
cy of ataxia in negroes, thrown some new light on the 
causes of hysteria, added a case of tactile amnesia and 
mind blindness to the literature, elucidated the pseudo-pa- 
ralysis of childhood, the spinal cord lesions and symptoms of 
ansemia and conjointly with Weir Mitchell, given us a record 
of some unusual cases of chorea, possibly involving the 
spinal cord. 

Wharton Sinkler's contributions to neurological medical 
literature include the Relations of Lead Palsy to Paralysis, 
to Mechanical Injuries of Nerves, Infantile Paralysis and 
Paralysig of Children, Adult Spinal Paralysis, Chorea in 
the Aged, Friedreich's Disease, Painless Facial Spasm, the 
Toe Reflex, Observations on Migraine, Brain Tumors, Syr- 
ingomyelia, Lesions of the Thalamus, Athetosis, Tremor, Pa- 
alysis Agitans, Poliomyelitis Anterior, etc. 

But these are not all the giants of Philadelphia. 
Though you will find among them, Ajaces, Boanerges 
and several Corypheuses in neurological medicine, here 
are some of the blows another giant (of this peaceful city), 
Charles K. Mills, has struck in opening the way to the 
high pinnacle on which American neurology stands to-day: 

"The Relation of Infectious Processes to Mental Dis- 
ease," "The Naming Centre," "The Localization of Lesions 
in the Pons and Pre -oblongata," "Phases of Syphilis of the 
Brain," "The Diagnosis of Intracranial Tumors," "Aphasia 
and Disorders of Pantomime," and "Treatment of Diseases 
of the Brain." 

Dr. Mills has nearly completed the first part of a Prac- 
tical Treatise on the Nervous System and its Diseases, a 



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Neurological Progress in America. 289 

volume of about one thousand pages, which wilt be issued 
by the J. B. Lippincott Company of Philadelphia, about the 
first of October of the present year, and every American 
neurologist will be proud of it. He is the author of too 
many neurological monographs to be here enumerated; his 
articles, clinical and pathological, include reports on many 
cases of brain tumor; numerous clinical lectures and re- 
ports on the affections of the nervous system; articles on 
hypnotism; medico-legal papers; the Toner Lecture on Men- 
tal Overwork and Premature Disease among Public and Pro- 
fessional Men, published by the Smithsonian Institution; 
articles on Hysteria, Hystero- Epilepsy, Catalepsy and Ec- 
stacy, in the American System of Practical Medicine; and 
in the same work, "Tumors of the Brain and its Envel- 
opes" (with Dr. J. Hendrie Lloyd) ; numerous reports on 
cases of insanity and papers on cerebral and spinal locali- 
zation, and "Cerebral Localization in its Practical Relations," 
Besides these names, those of Spiller and Marineso come to 
me, but a record of the work must now be deferred to the 
Appendix. 

As 1 close this report I note that the leading articles in 
many of the latest issues of the leading journals of the country 
are on advanced neurological subjects. Lewellys F. Barker, 
in the New York Medical Journal, continues his interesting 
contributions on the Nervous System and its constituent 
neurons; Allan Bonar, in the Record, gives us new light on 
many disturbances in locomotor ataxia, and Henry Hun, 
who has contributed much in years gone by, gives an in- 
structive study of analgesia, thermic anaesthesia and ataxia, 
from focal softening in the medulla oblongata and cerebel- 
lum, due to occlusion of the left inferior posterior cerebellar 
artery; further enlightening uk on the course of the sensory 
and coordinating tracts in the medulla, and Henry M. Ly- 
man, of Chicago, in the Journal of the A. M.A. for May 
22nd, elaborates the subject of Nervous Dyspepsia with 
proofs of the position taken on this subject (though he 
does not name them as such) by Brigham seventy years 
ago and referred to in the beginning of this essay. 

During the past year there has appeared in my journal 



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290 C. H. Hughes. 

atone advanced neurological articles on the following sub- 
jects: "The Anastomoses Between the Spinal Accessory 
and the Vagus," by Drs. D. Mirto and E. Pusateri; "Some 
Current Errors Regardiug Insanity," by Dr. Arthur E, 
Mink; "A Case of Chronic Chorea, with Pathological 
Changes Similar to those of General Paresis," by Dr. E. 
D. Bondurant; "A Note on the Treatment of Sexual Inver- 
sion," by Havelock Ellis; "The Advancement of Psychiatry 
in America and the Relation of Psychiatry to General Med- 
icine," by Dr. Edward Cowles; "Abuse of the Bromides," 
by Dr. Harriet C. B. Alexander; "An Ataxic Paranoiac of 
Genius," by Dr. J. G. Kiernan; "Hysterical Analgesia," 
by Dr. C. C. Hersman; "State Care and State Mainten- 
ance for the Dependent Insane in the State of New York," 
by Dr. Carlos F. MacDonald; "Nervous Shock and Disease 
of the Nervous System as a Cause of Pernicious Ana;mia," 
by Dr. James B. Herrick; "Differential Diagnosis of Insan- 
ity," by Dr. C. B. Burr; "Observations on the Histological 
Development of the Cerebellar Cortex in Relation to the 
Faculty of Locomotion," by Dr. Aurelio Lui; "Scrivener's 
Palsy not Solely Pen Fatigue," by Dr. C. H. Hughes; 
"Are Americans Degenerates?" by Dr. Jas. G. Kiernan; 
"Sociology and the Realistic Novel," by Dr. Ingeborg Tau- 
strom; "The Surface Thermometry of the Head in Diseas- 
es of the Brain," by G. W. McCaskey; "Syphilis as an 
Aetioiogical Factor in the Production of Locomotor Ataxia," 
by Dr. C. Travis Drennen; "The Psycho-Neural Factor in 
Medical Practice," by Dr. C. H. Hughes; "Psychical Herm- • 
aphroditism," by Dr. William Lee Howard; "Preputial Re- 
flex Epileptiform Convulsions, with Report of a Case," by 
Dr. Alex L. Hodgdon; "Intemperance, Consanguine Mar- 
riages, and Educational Overpressure, as Factors in the 
Genesis of Nerve Disease and Degeneration of the Race," 
by Sir Frederick Bateman, M, D.; "What is Meningitis?" 
by Dr. W. S. Christopher; "The Case of Sturgeon Young, 
a Question of Hypnotic Injury and Death," by Clark Bell, 
Esq.; "Encephalitic and Late Epilepsy," by Dr. J. G. 
Kiernan; "Psychoses of Old Age," by Harriet C. B. Alex- 
ander; "The Auto- Toxic Origin of Epilepsy," by Dr. J. 



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Neurological Progress in America. 291 

Nelson Teeter; "Insane Heredity," Dr. H. P. Stearns; "An- 
algesia of the Ulnar Nerve in the Insane," by Dr. Arrigo 
Giannone; "Report of a Case of Brain Syphilis Heroically 
Treated with Mercury, Followed by a Mercurial Neuritis and 
Recovery," by Dr. William C Krauss; "Interaction of So- 
matic and Psychic Disorder," by Dr. James G. Kiernan; 
"Imperative Conceptions," Dr. C. H. Hughes; "Defence of 
Modern Psychiatry," Dr. Wm, Hirsch; "Cyclone Neuroses," 
Dr. C. H. Hughes; and "The Effects of Extirpation of the 
Parathyroid Glands," by Prof. G. Vassale and Dr. F. Gen- 
eral; while the list for the past ten years is a complete 
record of neurological progress. 

Following our own protest in 1882 against reckless oopho- 
rectomy,* because "the neuropathic diathesis could not be oblit- 
erated with the removal of an ovary," and condemning that 
"gynecological reasoning which discerns through the spec- 
ulum special and exclusive channels of communication with 
the brain, not revealed by physiological or anatomical research 
and never dreamed of in regard to the other sex," as 
untenable; Geo, J. Preston, of Baltimore, in a monograph 
just from the press, emphasizes anew this past condemnation 
of the unduly meddlesome and murderous gynecological sur- 
gical attempt "without perceiving it * * to remove by the 
knife an hysterogenic zone." His book is entitled, "Hys- 
teria and Certain Allied Conditions." 

It is thus that American Neurology and Psychiatry 
moves up to the mountain top. If you don't concede that 
it is already there, you see we are getting there. The la- 
bors of the past three decades, as well as the work of the 
pioneers, have won for us a place at least beside our wor- 
thy brothers abroad in the world's neurological progress. 
We at least are lending a helping hand, of which we need 
not be ashamed, in making its history. We are moving up 
with the world and moving the world up with us. 

Addendum. As I do not wish to repeat in this report 
on Progress it should be read in connection with my address 
as President of the section on Neurology and Psychiatry of 



jdbyGoogle 



292 C. H. Hughes. 

the first Pan American Medical Congress, at Washington, in 
1883, to which the reader is referred in the ALIENIST AND 
NEUROLOGIST and Journal of the American Medical Asso- 
ciation of that year. 



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BIBLIOGRAPHY. 

DR. WM. B. ATKINSON:— Lecturer on Diseases of 
Children, Jefferson Medica) College, Philadelphia — "Note 
on Night Terrors," ALIENIST AND NEUROLOGIST, vol. 
iii.. No. 4. 

DR. RICHARD ittAURICE BUCKE;— "Man's Moral 
Nature." 

DR. GEO. M. BEARD:— "Nervous Exhaustion; Neu- 
rasthenia," 1880. "American Nervousness; Us Causes and 
Consequences," 1881. 

DR. D. R. BROWER:— Six Reports of the Medical 
Superintendent of the Eastern Lunatic Asylum for the years 
1870, 1871, 1872, 1873. 1874 and 1875 respectively, and 
published by the Commonwealth of Virginia, Richmond, Va., 
in above years. 

"A case of Suicidal Melancholia," Chicago h4eJicalJour- 
nal and Examiner, Vol. 33, p. 690, 1876. 

''Traumatic Insanity in its Medico- Legal Relations." 
Ibid. Vol. 39, p. 609, 1879. 

"A New Surface Thermometer," Ibid, Vol. 40, p. 505, 
1880. 

"Hyoscyamia," Ibid, Vol. 41, p. 261, 1880. 

"Traumatic Tetanus," Ibid, Vol. 45, p. 449. 1882. 

"A Case of Epileptiform Convulsion and Paralysis due 
to Syphilitic Tumor,"/*/./, Vol. 46, p. 21, 1883. 

"Concealed Insanity, as Illustrated by Case of Mark 
Gray," Ibid, Vol. 47, p. 289, September, 1883. 

"The Effects of Cocaine on the Central Nervous Sys- 
tem," Ibid, Vol. 52, p. 173, 1886. 

"A Clinical Lecture on Tubercular Meningitis," JoMrwa/ 
American Medical Association, January 7, 1888. 

"A Clinical Lecture: Poliomyelitis Anterior Acute," 
Chicago Medicaljoumal and Examiner, Vol. 46, p. 273, 1888. 

[293] 



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294 C. H. Hughes. 

"A Clinical Lecture on Hemicrania," tVestern Medical 
Reporter, March, 1888. 

"Exophthalmic Goitre and its Treatment by Tincture of 
Strophanthus," Journal Amer. h4ed. Assn., Nov. 3, 1888. 

"The Clinical Uses of Electricity," Chicago Medical 
Journal and Examiner, Dec, 1888. 

"The Clinical Uses of Electricity," Ibid, Vol. 48, p. 
1, 1889. 

"The Treatment of Locomotor Ataxia," Proceedings 
International Medical Congress, Berlin, 1890. 

"Cerebral Paralysis," Clinical Lecture delivered at 
Woman's Medical College, Dec. 1892. 

"Cerebral Paralysis" Chicago Clinical Review, Vol. 1, 
p. 193, 1893. 

"Prevention and Treatment of Cholera," Ibid, p. 14, 
Vol. 2, 1893. 

"Neurological Clinic: Multiple Sclerosis; Lateral and 
Specific Sclerosis," Ibid, Vol. 2, p. 37, 1893. 

"Neurological Clinic; Mania, Paralysis Agitosis, Cere- 
bro-Spinal Meningitis," Ibid, Vol. 2, p. 995, 1893. 

"Multiple Neuritis of Rheumatic Origin and Brain Par- 
alysis," Ibid, Vol. 2, p. 377. 1893. 

"Some Suggestions as to Treatment of Cerebral Hemor- 
rhage," Ibid, Vol. 3, p. 89, 1893. 

"The Murderer of Mayor Harrison, a Paranoiac," The 
Chicago Magazine of Current Topics, February 1894. 

"Medical Expert Testimony," read before the Illinois 
State Medical Society, 1894. 

"A Case of Gumma of the Cerebrum," Jour. Amer. 
Med. Assn., Vol. 24, No. 2, 1894. 

"Cerebral Meningitis; Lead Poisoning; Alcoholism," 
International Clinics, Vol. 1, 4th series, 1894, Philadelphia. 

"Clinical Lecture on Mental Diseases," Chicago Clin- 
ical Review, Vol. 3, p. 597, 1894. 

"Some Suggestions in the Treatment of Locomotor 
Ataxia," The Corpuscle, Chicago, October, 1895. 

Clinic: "Paralysis, Brain Disease, Primary Lateral 
Sclerosis, Brain Disease," Chicago Clinical Review, Vol. 4, 
p. 291, 1895. 



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Neurological Progress in America. 295 

"Cerebral Meningitis; Concussion of the Brain; Sci- 
atica; Two Cases of CMotea," International Clinics, \o\. 1, 
5th series, 1895. Philadelphia. 

Chairman's Address, Section on Neurology and Medical 
Jurisprudence, 46th Annual Meeting American Medical Asso- 
ciation. Subject: "Progress in Heuro\o^," Journal Amer. 
Med. Assn.. Vol. 25, No. 21, 1895. 

"Auto -Infection in Diseases of Nervous System, and 
its Treatment," Chicago Clinical Review, \o]. 5, p. 160, 1895. 

President's Address, Illinois State Medical Society, 1895. 
Subject: "The Medical Aspects of Crime." 

"Aphasia, Cerebral Hemorrhage," International Clinics, 
Vol. 4, 4th series, 1895, Philadelphia. 

"Two Cases of Epilepsy," /bid. Vol. 4, 4th series, 
1895, Philadelphia. 

"The Teaching of Materia Medica and Therapeutics," 
American Medical Association, Atlanta, 1896. 

"On the Regulation of Marriage," American Medical 
Association, 1896. 

"The Necessity of Granting Privileged Civmmunications 
to the Medical Profession in the State of Illinois." Read 
before the Medico-Legal Society, December 5, 1896. 

"Relation of Certain Diseases of the Nervous System 
to Life Insurance," Chicago Clinical Rerit'o.', Vol. 5, p. 358, 
1896. 

"Some Suggestions as to Treatment of Cerebral Hemor- 
rhage," Ibid, Vol. 5, p. 538, 1896. 

"Hemiplegia; Epilepsy; Apyretic Typhoid Fever; Prob- 
able Meningitis; General Myelitis," Intenititional Clinics. 
Vol. 1, 6th series, 1896. 

"Hemiplegia; Epilepsy; Apyretic Typhoid Fever, Inter- 
national Clinics, Vol. 1, 6tli series, 1896. 

"The Habitual Criminal." Report of Special Committee, 
Chicago Medico-Legal Society, 1896. 

"Anaemia, Some Suggestions in Diagnosis and Treat- 
ment," North American Practitioner, Chicago, Sept., 1896. 

"Cerebral Syphilis: Some Observations on its Diag- 
nosis and Treatment," The Peoria MedicalJoumal, October, 
1896. 



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2% C. H. Hughes. 

"The EtioloEical Factors in Crime and Treatment of 
Criminals," New York Medico-Legal Society, July, 1896. 

"Four Cases of Diplegia in a Family of Five." Read 
before the Chicago Academy of Medicine, December, 1896. 

"Clinical Lecture on Mental Diseases," Chicago Clin- 
ical Review, Vol. 6, p. 136, 1896. 

"Friedreich's Ataxia or Hereditary Ataxia;" Clinical 
Lecture, Woman's Medical College, Jowrwa/ American Xiedical 
Association, April 24, 1897. 

DR. AMARIAH BRIGHAM:— "Mental Cultivation and 
Excitement," 1845. "Brigham on the Brain," 1840. 

DR. J. K. BAUDUY:^" Diseases of the Nervoos Sys- 
tem." "Automatic Cerebration" and other papers. 

DR. LEWELLYS F. BARKER:— "The Anatomy and Phy- 
siology of the Nervous System and its Constituent Neurones, 
as Revealed by Recent Invesiigations," N. Y. Med. Journal, 
May 15, 1897, etseq.. 

DR. CHAS. W. BURR:— "Unusual Cases of Chorea. 
Possibly Involving the Spinal Cord." With Dr. S. Weir 
Mitchell, Journal of Nervous and Mental Disease, July, 
1890. 

"The Frequency of Locomotor Ataxia in Negroes." 
Ibid, April, 1892. 

"A Case of Tactile Amnesia and Mind Blindness." 
Ibid, May, 1897. 

"A Contribution to the Pathology of Friedreich's 
Ataxia." Uuiversiiy Medical Magaxi/ie, June 4, 1892. 

"The Pseudo- Paralysis of Childhood." Ibid, May, 
1896. 

"The Spinal Cord Lesions and Symptoms of Pernicious 
Ana:'mia." Ibid, April, 1895. 

"The Causes of Hysteria." International Clinics, vol- 
iv, sixth series. 

"The Eye in Hereditary Ataxia," With a Report of 
Four Cases of Friedreich's Ataxia in one Family. Annals of 
Ophthalmology, January, 1897. 

DR. J. W. COURTNEY:— "Some Nervous Symptoms of 
Diabetes and Interstitial Nephritis." Read before the Nor- 



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Neurological Progress in America. 297 

folk District (Mass.) Medical Society, November 24, 1896, 
and published in tlie Medical Times and Register. 

DR. S. V. CLEVENGER:— "Cerebral Topograpliy," 
Journal of Nervous and Mental Disease, Oct. 1879. 

"The Sulcus of Rolando and Intelligence," Ibid, April, 
1880. 

"Post Mortem Examination of the Brain," Chicago 
Medical Gazette, March, 1885. 

"Plan of the Cerebro-Spinal Nervous System," yoHrna/ 
of Nervous and Mental Disease, Oct., 1885. 

"Comparative Neurology," American Naturiilist, Jan. 
and Feb., 1881. 

"Origin and Descent of the Human Brain," Ibid, July, 
1881. 

"Cerebral Anatomy Simplified," Chicago MedicalJounial 
and Examiner, Nov., 1895. 

"Medical Electricity," Ibid, Oct., 1881. 

"Nerve Cells and their Functions," Inaugural Thesis 
American Neurological Society anticipating the recent 
"neuron" theory, Chicago Med. Review, March 11th 1881; 
in full in "Comparative Physiology and Psychology," 1885. 

"Contributions to Comparative Psychology," Science, 
New Yorlt, May and July, 1881. 

"Insanity in Chicago," Chicago Medical Journal and 
Examiner, Nov., 1883. 

"Clinical and Pathological Reports ofCases of Insanity," 
Ibid, 1883, 1884. 

"Delirium Grave," Journal of Neurology and Psychiatry, 
August, 1883. 

"Insanity in Children," Ibid. 

"Nervous and Mental Physics," Ibid, 1884. 

"Paretic Dementia in Females," ALIENIST AND NEU- 
ROLOGIST, Jan. 1884. 

"Comparative Physiology and Psychology," 200 pp., 
1885. 

"Neurological Notes," Western Med. Reporter, Jan., 1886. 

"Contributions to Neurological Therapeutics," Journal 
of Nervous and Mental Disease, Feb. 1885., 



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298 C. H.Hughes. 

"Jurisprudence of Mental and Nervous Diseases," 
ALIENIST AND NEUROLOGIST, Oct. 1887. 

"Traumatic Insanity," ALIENIST AND NEUROLOGIST, 
July, 1880. 

Numerous articles in The Open Court, 1887. 

"Spinal Concussion," 400 pp,, 1889. 

"Mental Hygiene," Philadelphia Med. Times and Regis- 
ter. March 29, 1890. 

"An Infant Prodigy," ALIENIST AND NEUROLOIST, 
July 1895. 

"Address to Chicago Academy of Medicine," Philadel- 
phia Times and Register, 1895. 

"Heart Disease and Insanity," ALIENIST AND NEU- 
ROLOGIST, Oct., 1890. 

"Ataxic Amaurosis," Chicago Med. Standard, 1895. 

"Inebriety Notes," Journal of Inebriety, 1890 and 1891. 

"Tile Coming Man," American Naturalist, July, 1891. 

"Catlin's Meteorological Pain Phenomena," Philadelphia 
Med. News, June, 1891. 

"Cerehrology and Phrenology," American Naturalist, 
July, 1888. 

"Softening of the Brain," Philadelphia Times and Regis- 
ter, July 4th, 1891. 

"Mental Suggestion," North Amer. Practitioner, Sept. 
1891. 

"Paretic Dementia," Open Court, Oct. 29, 1891. 

"Psychological Studies of Physicians," Z.OH/sf (7/^ Mfrfi- 
cal Progress, Dec. 1891. 

"Language and Max Muller,"-4;;;cr. Nalnralist,J^ov., 1891. 

"Mania," Open Court, Jan. 28th, 1892. 

"Rheostats," North Amer. Practitioner, Dec, 1891. 

"Natural Analysis," Amer. Naturalist, March, 1892. 

"Alcoholic Insanity," North Amer. Practitioner, March, 
1892. 

ia," Times and Register, Aug. 29th, 

Legal Testimony," Times and Register, July 





"Periodic. 


al M 


1801 








"IWcJico 


Li'l 


Otli, 


1892. 





,db,Googlc 



Neurological Progress iti /fmerica. 299 

"Erichson's Disease," Sos/oh Medical and SurgicalJour- 
nal, 1892. 

"Brain Centers," American Naturalist, Sept. 1892. 

"Brain and Skull Correlations," Science, New York, 
Oct. 21. 1892. 

"Sleep," Science, Nov. Ilth, 1892. 

"Unconscious Concentration," Science, Feb. lOth, 1893. 

"Sleep, Sleeplessness and Wypnoixcs," Journal of Amer. 
Med. Assn., March 10th, 1894. 

"Mysophobia," iVesteni Med. Reporter, Nov., 1894. 

"Conservative Brain Surgery," Journal of Amer. Med. 
Assn., June 29th, 1895. 

"Post A\coho]\sm," Journal of Inebriety, Oct., 1895. 

"The Meramils," Journal oj Amer. Med. Assn., Feb. 
22, 29, 1895. 

"Treatment of the Insane," /*;</, Oct. 24th, 1896. 

"Paiji andltsTherapeiisis," /fr/i/, Jan. 30tli, 1897. 

"Medical Jurisprudence of Insanity," 2000 pages, .1897, 
in press. 

DR. LEONARD J. CORNING:— "Brain Exhaustion" and 
other t)ooks and articles. 

DR. T. D. CROTHEHS:— "Law of Periodicity in Ine- 
briety" (vide ALIENIST AND NEUROLOGIST, July, iSf)2), 
showing a uniformity in the drink impulse and the laws 
which regulated it. 

"Some New Studies of the Opium Disease," read before 
the Philadelphia County Medical Society, Jan., 1892, point- 
ing out a neurotic diathesis and various conditions favoring 
the disease. 

"Are Inebriates Curable?" read before the English 
Society for the Cure of Inebriety, June, 1892, proving the 
curability and the periodicity from further study in this 
direction. 

"Sanitary Side of the Drink Problem," read before the 
American Medical Association, June, 1892, discussing the 
sanitary dangers from neglect of control of inebriates. 

"Medical Jurisprudence in Inebriety" {vide Internalioiul 
Magazine, February, 1893) ; an argument to prove the need 
of a new legislation for inebriates. 



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300 C. H. Hughes. 

"American Inebriate Asylums," read before the Amer- 
ican Medical Association, June, 1893, being a historical 
review of asylum treatment for inebriates. 

"Criminal Inebriates and Treatment," read before the 
Congress of Criminology, Jime, 1893. 

DR. ROBLEY DUNGLISON:— "Dunglison's Medical Dic- 
tionary," 1832. 

DR. CHARLES L. DANA:— "Pathology and Symptom- 
atology of Apoplexy." 

1. "Forms of Cerebral Hemorrhage," Medical Record, 
August, 1890. 

2. "Diagnosis of Intra-cranial Hemorrhage and Acute 
Softening," Medical Record , July 25, 1891. 

3. "Vertigo in Temporal Lobe Lesions," Journal of f^er- 
voiis and Mental Disease, July, 1889. 

4. "Hemorrhage in Cerebral Abscess." 

5. "Primary Hemorrhage in Lateral Ventricle," Journal 
of Nervous and Mental Disease, 1892, p_. 47. 

6. "The Apoplectic Pulse." ' Post -Graduate, 1893, 
p. 276. 

7. "Apoplexy in Relation to Temperature of the 
Body." American Journal of the Medical Sciences, June, 1894. 

8. Same Subject. Post -Graduate, July, 1896. 

"The Localization of Cutaneous Sensations." 1. Med- 
ical Kecord, May 13, 1893. 2. Journal of Nervous and Men- 
tal Disease, December, 1894. 3. Same, October, 1888. 

"Ak-ohdiism, Clinical Studies." I. New York Medical 
Journal, June 14, 1890. 2. Medical Kecord, March 19, 
1892. 3. American Journal of Insanity, July, 1893. 4. 
Post -Graduate, July, 1896. 5. New York' Neurological Soci- 
ety Reports, April, 1897. 

"The Cause of Perforating Necrosis of the Spinal Cord." 
1. ALIENIST AND NEUROLOGIST, April, 1889. 2. Post- 
Graduate Neurological Rcport-i, Post -Graduate, July, 1897. 

"The Combined Scleroses of the Spinal Cord; their 
Nature." \. Journal of Nervous and Mental Disease, April, 
1891. 2. Medical Record, July 2, 1887. 3. Brain, January, 
1889. 

"Thu Pathology of Chorea." 1. Case with Autopsy, 



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Neurological Progress in America. 301 

Brain, 1889. 2. Microbic Origin of Chorea, Journal of Ner- 
vous and Mental Disease, January, 1894. 3. "Pathology of 
Hereditary Chorea; Case and Autopsy," American Journal 
of the Medical Sciences, September, 1895. 
^ "Pathology of Paralysis Agitans." 1. Case and Au- 
topsy, New York Medical Journal, June 10, 1894. 2. Same, 
Posl-Graduate, July, 1897. 

"Acromegaly and Giantism," Journal of Nervous and 
Menial Disease, December, 1893. ''Acromegaly and Facial 
Hemihypertrophy," IMarch, 1894. 

Text-booh of Nervous Diseases, now going into the 4th 
edition. 

The Pathological Anatomy of Tic Douloureux. The 
Treatment of Tic Douloureux. 

In 1888, Dr. Dana described in the ALIENIST AND NEU- 
ROLOGIST a case of transverse myelitis, which showed post- 
mortem a perforating necrosis, occupying the posterior column 
of the spinal cord. The myelitis, in this case, began suddenly, 
and a complete paraplegia developed in a fewdays. The his- 
tory was lil<e that of an acute h;emorrhagic process. Post- 
mortem, there was found to be an acute meningo-myelitis at 
the upper portion of the dorsal cord, the myelitis being eventu- 
ally suppurative, if not primarily so. The necrosis extended 
down below it and showed no evidence of there being any 
haemorrhage in connection with it, even at its lowest point. 
It was a pure and simple necrotic condition. The sections 
were shown before the New York Neurological Society, and 
were there seen by Drs. Biggs, Heitiiman, Amidon, and a 
number of other neurologists. 

Since the publication of this case, Dr. Ira Van Gieson 
has reported another one, putting forward the theory, sup- 
ported by some experiments, that the process is primarily 
hemorrhagic. Dana now records another case of perforating 
necrosis, which shows that the nature of the process is pri- 
marily necrotic, yide Post Graduate, \o\. XI., No. 7. 

Dr. Dana also believes that the perforating necrosts 
which accompany some severe cases of myelitis, are really 
tubercular phenomena, and not primarily hiemorrhagic. 



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302 C. H. Hughes. 

although in some instances, there may be a hemorrhagic 
process associated with it. 

DR. M. GONZALEZ ECHEVERHIA:— On Epilepsy; An- 
atomrt-PaOioiogical and Clinical Notes, 1870. 

JEREMIAHT.ESKRIDGE:— "Tumor of the Brain." Read 
before the Pathological Society. Philadelphia, Nov. 14, 1878 
Fliilailelphia Traiisacfiom, 1878-9. 

"Report of Three Cases of Abscess of the Brain." 
Kead before the Philadelphia College of Physicians and 
Surgeons. M:>y i, 1882. IbiJ, 1883. 

"Tubercular Cerebro- Spinal Meningitis." Philadelphia 
College of Physicians and Surgeons, April 4, 1883. Ibid, 
1883. cl. 

"Case of General Neuralgia." Read before the Amer- 
ican Neurological Association, June 20, 1883. Archives of 
Medicitie, Oct., 1883, vol. 10, No. 2. 

"Tumor Cerebellum, with Monocular Hemianopia." 
Read before the El Paso County Medical Society, Colorado 
Springs, Jan., 1885. Journal of Mental and Nervous Disease, 
Jan.. 1885. vol. 12, No. 1. 

"Diagnosis of Diseases of the Nervous System," Read 
before the El Paso Medical Society, Colorado Springs, 1885. 
Philadelphia Medical Bullet in, I88S. 

"Nervous and Mental Diseases Influenced by the Cli- 
mate of Colorado." Pbiladelphia Neurological Society, 1887. 
Journal of NeiDous and Mental Disease, Sept., 1887, vol. 14, 

"A Strange Homicide Case." Read before the Phila- 
delphia Medical Jurisprudence Society, 1887, ALIENIST AND 
NEUROLOGIST, Jan. 1888. 

"Certain Localized Lesions of Brain and their Practical 
Relations." Read before the Colorado State Medical Society, 
June, 1888. Ibid, July. 1888. 

"Tetanus." Read before the Arapahoe Medical Society, 
1889. Denver Medical Time!., 1889. 

"Spinal Irritation, Diagnosis of Affections Mistaken for 
It," Read before the Colorado State Medical Society, June, 
1889. ALIENIST AND NEUROLOGIST, July, 1889. 

"Abscess of Brain. Operation. Death, Ninth Day,"' 
Kead before the El Paso Medical Society, Colorado Springs, 



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Neurological Progress in America. 303 

1888. Journal of Nervous and Mental Disease, June, 1889. 

"Syphilis of the Brain," Read before the Arapahoe 
County Medical Society, Denver, March, 1889. Ibid, April, 
1889. 

"Acute Myelitis, Preceded by Acute Optic Neuritis." 
Read before the American Neurological Association, 1890. 
Ibid, Sept., 1890. 

"The Medical Expert." Read before the Denver Med- 
ico-Legal Society, November, 1899. Philadelphia Medical 
News. 1890. 

"Nervous and Mental Diseases Observed in Colorado." 
Read before the American Climatological Association, Denver, 
Sept. 3, 1890. N. Y. Medical Journal, October 25, 1890. 

"Diagnosis, Certain Simulated Mental and Nervous 
Diseases." Read before the Colorado State Medical Society, 
June, 1890. Ibid, July 21, 1890. 

"Chorea in Relation to Climate in Colorado. . Read 
before the American Climatological Association, 1892. The 
Climaiologist, Aug., 1891. 

"Fracture 12th Dorsal Vertebra." Injury to Spinal and 
Sympathetic Nerve Supply of Bowel — lleo-coecal Region; 
Intestinal Hemorrhage; Death. Read before the American 
Neurological Association, Washington, Sept. 23, 1891. Medi- 
cal News, Oct. 10, 1891. 

"Gunshot Wound, Left Cuneus, with Right Homony- 
mous Hemianopsia." Read before the American Neurolog- 
ical Association, Washington, Sept. 24, 1891. Ibid, Oct. 
17, 1891. 

"Poliomyelitis with Perineuritis." Clinical Lecture, 
Arapahoe County Hospital, Oct. 17, 1891. N. Y. Medical 
Journal, Dec. 26, 1891. 

"Hypnotism," Read before the Colorado State Medical 
Society, June 16, 1891. Ibid, Aug. 1, 1891. 

"Nervo-Vascular Disturbance in Unacclimated Persons 
in Colorado." Head before the American Climatological 
Association, Washington, Sept. 22, 1891. The Climaiologist, 
March, 1892. 

"Myelitis, Case of Incipient Posterior Spinal Sclerosis." 



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304 C. H. Hughes. 

Clinical Lecture. Arapahoe County Hospital, 1892. Inter- 
national Medical Magaiine, April, I8Q2. 

"Subacute Recurrent Multiple Neuritis." Clinical Lec- 
ture Arapahoe County Hospital, Oct. 3, 1891. Journal of 
Nervous and Mental Disease, Feb., 1892. 

"Ataxia." Clinical Lecture, Arapahoe County Hospi- 
tal, Nov., 189L International Clinic, Jan., 1892. 

"Care of Idiot. Education of the Feeble Minded." 
Read before the State Association of Charities and Correc- 
tions, 1891. Denver Medical Times, 1891. 

"Tumor of the Brain," Clinical Lecture, Arapahoe 
County Hospital, Oct. 31, 1891. Ibid, January, 1892. 

"Diagnosis and Nature of Certain Functional and 
Organic Nervous Diseases," Read before the El Paso 
County Medical Society, Nov. 1, 1891. ALIENIST AND 
NEUROLOGIST, Jan., 1892. 

■'Retro-anterograde Amnesia. Two Cases," Read before 
the Colorado State Medical Society, June, 1892, Ibid, 1892. 

"Expert Witnesses." Denver Bar Association and 
Medico-Legal Society, March 3, 1892. Denver Medical Times, 
May, 1892. 

"Poliomyelitis." Clinical Lecture Arapahoe County 
Hospital, Oct. 24, 1891. Medical News, Feb. 20, 1892. 

"Chronic Meningo-Myelitis." Clinical Lecture Arapa- 
hoe County Hospital, Oct. 29, 1892. Ibid, April. 1893. 

"Periostitis of Pelvic Bones, Following Typhoid Fever" 
Clinical Lecture, Arapahoe County Hospital, Oct. 15, 1893. 
Kansas City Medical Index, January, 1893. 

"Idiopathic Muscular Atrophy," Clinical Lecture Arap- 
ahoe County Hospital, October 3, 1893. Jovrnal Nervous 
and Menial Disease, April, 1893. 

"Poliomyelitis," Clinical Lecture, Arapahoe County 
Hospital, February, 1893. Texas MedicalJournal, July, 1893. 

"Cases Poliomyelitis, Chorea, Sacro- lilac Arteritis." 
Clinical Lecture, Arapahoe County Hospital, October, 1893. 
Virginia Medical Monthly, November, 1893. 

"Tumor, Cerebellum." Clinical Lecture Arapahoe 
County Hospital, October, 1893. International Medical Mag • 
aiine, November, 1893. 



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Neurological Progress in America. 305 

"Report of Cases of Moral Imbecility, Opium Habit, 
Feigning, in Forgery." Read, Denver Medico-Legal Society, 
December, 1892. Medical News, January 14, 1893. 

"Traumatic Myelitis," Clinical Lecture Arapahoe 
County Hospital, October, 1892. Ibid, March 4, 1893. 

"Diagnosis, Treatment, Intra-Cerebral Hemorrhage; 
Treatment of Chorea." Read at Colorado State Medical Society, 
June 22, 1893. Ibid, Sept. 30, |893. 

"Sarcoma of Pia and Brain, Simulating Brain Tumor, 
Mono-Spasm and Mono-Paresis." Operation, Death. Read 
Section of Neurology and Medical Jurisprudence, 44th An- 
nual Meeting American Medical Association. Journal Amer- 
ican Medical Association, September 30, 1893. 

"Syringo-Myelia." Clinical Lecture Arapahoe County 
Hospital, March. 1893. International Clinics, 1893, vol. iii, 

"Bilateral Cerebral Thrombosis Due to Syphilitic Art- 
eritis." Clinical Lecture at the Arapahoe County Hospital, 
December, 1893. Medical News, Jan. 6, 1894. Reprint IS p. 

"Syringo-Myelia." Clinical Lecture at the University 
of Colorado, February, 1894. International Climes, 1893. 

"Neuralgia of the Right Fifth Cranial Nerve of 16 Years 
Duration." Excision of the Three Divisions at the Gasserian 
Ganglion. American Journal of Medical Sciences, 1894, 

"Fracture 12th Dorsal and 1st Lumbar Vertebrse, etc," 
Clinical Lecture Arapahoe County Hospital, March 1, 1894. 
Gaillard's Medical Journal, 1894. 

"Tumor of the Brain Simulating a Vascular Lesion." 
Clinical Lecture at the Arapahoe County Hospital, March, 
1894. Medical News. 

"Fracture of the Skull; Trephining, Retro- anterograde 
Amnesia, etc." Ibtti, 1894. 

"Trigeminal Neuralgia, etc." American Journal of Med- 
ical Sciences, 1894. 

"Some General Considerations in the Prevention and 
Treatment of Nervous and Mental Diseases; Prophylaxis; 
Diet; Exercise; Climate; Hydrotherapy; Electrotherapy." 
The American Text-book of Applied Therapeutics (in prep- 
aration). 

"Treatment of Vaso-motor Atrophic Diseases." Amer- 



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306 C. H. Hughes. 

ican Text-book of Applied Therapeutics (in preparation). 

"Trephining in Three Cases of Epilepsy; Two of the 
Jacksonian Variety; One due to old Meningeal Hemorrhage; 
Improvement." The Medical News, October 13, 1894. 

"Multiple Neuritis, with Development of Unilateral 
Facial Paralysis Late in the Course of the Disease." One 
Lecture. Ibid, December 22, 1894. ■ 

"Caries of the Spine; Followed by Compression of the 
Cord," Two Lectures. The New York Medical Journal, Nov. 
17-24, 1894. 

"Tumor of the Cerebellum with Bulimia and Recurrent 
Epileptiform Seizures." The Boston Medical and Surgical 
Journal. Jan. 10, 1895. 

"Amyl Nitrite; Animal Extracts and Juices; Anodynes 
anti - Neuralgic ; Bromides ; Bromoform ; Hypnotism ; Nerv- 
ines; Nitro-Glycerine; Neuciein; Porosmic Acids (osmic 
acid) ; Spinants. Handbook of Therapeutics (in Preparation). 

"Syphilis and Alcoholism of the Brain, Spinal Cord, 
and Probably of the Nerves of the Legs; Followed by Hys- 
terical Contractures of the Flexors of the Knees and Pro- 
nounced Variability of Certain Reflexes." The Medical News. 

"Report of a Case of Chronic Poliomyelitis and Chronic 
Multiple Neuritis." The Climalologisl, February, 1895. 

"Articles on: Tumor; Abscess and Sclerosis of the 
Brain; Chronic Hydrocephalus and Chronic Meningo- En- 
cephalitis." The American System of Medicine (in Prep- 
aration). 

"Report of Cases of Brain Lesions, Abscesses, Menin- 
gitis and Sinus Thrombosis, Resulting from Disease of the 
Middle Ear." Medicine, May, 1895. 

"Traumatic Cyst of the Brain," from an injury re- 
ceived twenty-five years before; Epilepsy; Operation; Re- 
covery, New York Medical Journal, June 1st, 1895. 

"Left Hemiplegia," followed by loss of the deep and 
superficial Reflexes; considerable muscular atrophy, marked 
Anaesthesia in the distant portions of the limbs, loss of Fara- 
dic irritability and reaction of degeneration of the muscles 
on the paralyzed side. Ihid, March 2, 1895. 

"Two Abscesses of the Brain," caused by Septic 



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Neurological Progress in America. 307 

emboli resulting from an old gun-shot wound of the right 
lung inflicted thirty-two years before; evacuation of one 
abscess; improvement; death from exhaustion, caused by 
Primary Abscess and old lung trouble. Ibid, Aug. 10, 1895. 

"Irritation of the Posterior Cerebral Fossa," for the 
relief of Basilar Meningitis. Read by title before the Amer- 
ican Neurological Association, in 1895. The Journal of Ner- 
vous and Mental Disease, 

"Three Cases of Chronic Abscess of the Brain." Med- 
ical News, July 27, 1897. 

"Four Cases of Mixed and Irregular Forms of Multiple 
Neuritis;" in which Paraplegia was the most prominent 
symptom in three and a condition simulating Hemiplegia in 
the fourth. Ibid, Nov. 2 and 9, 1895. 

A Series of Articles on speech defects as localizing 
symptoms. From a study of six cases of Aphasia. Ibid, 
June 6th to Sept. 19th, 1896. 

"Tumor of the Brain," with double Nasal Hemianop- 
sia. In/eniational Clinics, vol. i., sixth series. 

"Diagnosis of Chronic Abscess of the Brain." Read 
before the Colorado State Medical Society, 1895. The Amer- 
ican Journal of Medical Sciences. 

"Temporary Abulic Agraphia," probably due to partial 
obstruction of the Superior Longitudinal Sinus. Colorado 
Medical Journal, June, 1896. 

"Glioma of the Brain, Etc." Denver Medical Times, 
June 1896. 

"Diagnosis of Tumors of the Brain," Read before the 
Colorado State Medical Society, June 17, 1896. Colorado 
Medical Journal, September, 1896. 

"Symptoms of Speech Disturbances as aids in Cere- 
bral Localization." Read by title before the Second Pan- 
American Medical Congress, November, 1896. University 
Medical Magazine, January, 1897. 

"Hypnotism in General Medicine;" a few suggestions 
from personal experience. IVestem Medical Review, Feb- 
ruary, 1897. 

"The Professional and Technical Schools," especially 
those of medicine, in their relation to the College Course. 



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308 C. H. Hughes. 

Read at the celebration of the completion of the New En- 
dowment Fund of ^200,000 for Colorado College, Colorado 
Springs, held February 21, 22 and 23, 1897. Colorado Med- 
ical Jourtml, March, 1897. 

The Chapters on "insanity and Feigned Diseases," 
for the American System of Medical Jurisprudence. 

DR. FRANK R. FRY:— The Etiology and Treatment of 
Chorea. A short review of some of the current litera- 
ture, 1896. 

A Case of Chorea, attended with Multiple Neuritis, 
1890. 

Chorea in the Aged, Report of a Case, 1891. 

Cases Illustrating the Co-existence of Chorea and Alien 
Spasmodic Phenomena, with Remarks on the Diagnosis, 
1892. 

A Second Case of Multiple Neuritis attending Chorea, 
1863. 

Fatal Chorea, with Report of a Case, 1896. 

Quinine in the Treatment of Chorea, 1894. 

Two cases of Raynaud's Disease, 1885. 

Electrical Dosage, 1887. 

Remarks on a Case of Infantile Hemiplegia, 1888. 

Haramyoclonus Multiplex, with Report of a Case, 1888. 

A Case of Acute Traumatic Tetanus, with Supervention 
of Scarlet Fever on the Seventh Day, Temperature 105", 
Albuminuria, etc., Recovery, 1892. 

A Plea for the Cai-e of the Feeble-Minded by the State 
of Missouri, 1895. 

The Signs of Degeneracy in Diseases of the Nervous 
System, 189S. 

The Sensory Symptoms in Three Cases of Syphilitic 
Spinal Cord Disease, 1895. 

The Bicycle and the Nerves, 1896. 

The Neuron Conception of the Nervous System; Some 
Physiological and Pathological Facts and Theories connected 
therewith. 1897. 

DR. WM. FULLER;— The Introduction of Veratrum Vir- 
ide in the Treatment of Puerperal Convulsions, 1866, pub- 
lished 1876. 



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Neurological Progress in America. 309 

The Treatment of Congestions and Hemorrhages by Arte- 
rial Sedatives which Remove Spasm of the Arterioles and 
Equalize the Circulation, 1866; a principle enunciated by 
Cullen. 

Paper on the Physiology of Convulsions, their relation 
to Chills; in which was combatted the prevalent belief that 
convulsions were caused by congestion of the brain, prov- 
ing by experiments upon animals that tlie opposite condi- 
tion of anemia was the true cause of spasm, Canada Medical 
Record, 1876. 

The Introduction of Morphia into the Treatment of Puer- 
peral Eclampsia and in the Convulsions of Children, Canada 
Medical Journal, 1878, (claimed ten years later by Dr. 
Clarke, Otsego, N. Y.) 

Observations on the Nature of Surgical Shock,in which it 
was shown that vascular spasm and subsequent paralysis were 
productive of shock by depriving the great nerve centers of 
the proper biood supply. He practiced transfusion of blood 
into a vein which, however, was not successful at that 
time, 1877. 

The Differentiation Between the Coma of Compression 
and that Due to Reflex Irritation Producing Spasm of the 
Cerebral Vessels ("Spurious Meningitis"), Canada Medical 
Record, IS77. 

Tapping the Lateral Ventricle for Effusion. Can. Medical 
Record, 1877. 

Two Cases Melancholia which were Successfully Treated 
by Phlebotomy, Discussed before Montreal Medical and Surg- 
ical Society, 1870. Not published. 

Discussion of the Relation BetweenDiseasesofthe Sex- 
ual System and Perverted Moral Emotions and Religious Ec- 
centricities, Montreal Medical Society, 187S. 

Anatomical Reasons to Account for the Nervous Symptoms 
of Exopthalmic Goitre, in which was pointed out that the 
enlargement of the gland in these cases was always in a 
lateral direction on account of the density of the cervical 
fascia in front, and that the symptoms were due to pressure 
upon important nerves, Detroit Lancet, December, 1877. 



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310 C. H. Hughes. 

Operation for the Relief of Dementia from Pressure; 
Success Temporary, U. B. A. Hospital, 1880. 

Drainage of Subarachnoid Fluid Followed by Immediate 
Relief to Respiration in Effusion after Continued Convulsions, 
Cerebro- Spinal Fever and Recommended in Delirium Tremens, 
1880. 

Necessity of Supporting the Mind of the Patient an Es- 
sential Factor in the Practice of Conservative Surgery, Mich- 
igan Medical Society Transactions, 1890. 

A Method of Localizing the Deeper Parts of the Brain in 
Relation to the Surface, Jour. Atner. Med. Association, 1893. 

Researches Into the Anatomy of the Brain with Which 
You are Familiar. 

Keloid is Caused by Injury or Disease of Nerve Endings 
and is of the Nature of Neuroma(?). 

DR. WILLIS E. FORD, of Utica, N. Y., early recognized 
the Syphilitic Psychoses, i^ide Journal of Insanity, vol. 
vxxi., page 73. 

DR. LANDON Carter gray:— Cerebral Thermometry. 

Researches on the Tendon Reflex. 

Diagnostic Signs of intra-cranial Syphilis. 

Diagnostic Signs of Melancholia. 

Treatise on Nervous and Mental Diseases. 

DR. W. J. HERDMAN:— Primary Lateral Sclerosis, 
Transactions Michigan State Medical Society, 1888. 

Exopthalmic Goitre, Transactions Midi. State Med. So- 
ciety, 1890. 

Cysticercus Tumor at the Base of the Brain, Transacs. 
Michigan State Med. Society, 1891. 

Electricity as a Therapeutic Agi^nt. What is Needed 
to Determine its Merits, Journal of American Medical Asso- 
ciation, June 13, '91. 

Some Experimental Results from the Use of Solanum 
Carolinense, Trans. Micltigan State Mfd. Society, 1894. 

Cerebral Abscess of Right Tempero-Splienoidal Lobe, 
Amer. Med. Ass'n, Milwaukee, 

Simple Neuritis, Michigan StaW Med. Society, 1896. 

Nerve Repair after Injury, Michigan State Med. Society, 
1897. 



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Neurological Progress in America. 311 

DR. WM. A. HAMMOND:— Physiological Memoirs, 1863. 
A Treatise on Hygiene, 1863. 
Lectures on Venereal Diseases, 1864. 
On Wakefulness, with a Chapter on the Physiology of 
Sleep, 1865. 

Insanity in its Medico-Legal Relations, 1866, 
Treatise on Diseases or the Nervous System, 1871, 
nine editions of which have been published, and it has been 
translated into French, Spanish and Italian. 

Physics and Physiology of Spiritualism, 1870. 
Clinical Lectures on Diseases of the Nervous System, 1894. 
Insanity in its Relation to Crime, 1872. 
Spiritualism and Allied Causes and Conditions of Ner- 
vous Derangement, 1876, 

A Treatise on Insanity and its Medical Relations, 1883. 
On Sexual Impotence, 1883. 

Besides these, about 100 articles published in medical 
journals. Originated the Army Medical Museum, the Army 
Medical Library and the Medical and Surgical History of 
the Rebellion, which were instituted by circulars published 
from his office as Surgeon General. 

DR. C. H. HUGHES;— "A Clinical Inquiry into the 
Significance of Absent Patellar Tendon Reflex." ALIENIST 
AND NEUROLOGIST, January, 1880. 

"The Medico-Legal Aspect of Cerebral LocaliEation and 
Aphasia." Ibid, April and July, 1880. 

"Reflex Cardiac Gangliopathy with Hereditary Diath- 
esis." Ibid, April, 1880. 

"Notes on Neurasthenia." Ibid, October, 1880. 
"Impending Periodic Mania." Ibid, October, 1880. 
"Nitrite of Amyl — fJifferential Diagnosis of Cerebral 
Hypera'mia and Ana;mia." Editorial, Ibid, October, 1880. 
"Moral Insanity, Depravity and the Hypothetical Case." 
Ibid, January, 1881. 

"Problem in Psychiatry for the Family Physician." 
Ibid, January, 1881. 

"Arrested Prodromal Insanity, with Auditory Hallucina- 
tions and Auto-Mysophobia," with Dr. D. V. Dean. Ibid. 



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312 C. H. Hughes. 

"Clinical Notes Illustrative of Consciousness of Epilep- 
sia." Ibid, April, 1881. 

"Illusion, Hallucination and Delusion. — A Differential 
Study for Forensic Purposes." Ibid, July, 1881. 

"Moral (Affective) Insanity." Ibid, January, 1882. 

"The Special Therapeutic Value of Hyoscyamine in 
Psychiatry." Ibid, April, 1882. 

"Note on the Essential Psychic Signs of General 
Functional Neuratrophia or Neurasthenia." Ibid, July, 1882. 

"Psychical Analysis of Guiteau." Ibid, October, 1882. 

"The Therapeutic Value of Cephalic and Spinal Elec- 
trizations." Ibid, January, 1883, 

"The Simulation of Insanity by the Insane." Ibid, 
July, 1883. 

"The Opium Psycho- Neurosis. — Chronic Meconism or 
Papaverism." Ibid, January, 1884. 

"Borderland Psychiatric Records — Prodromal Symptoms 
of Psychical Impairment." Ibid, July, 1884. 

"Migraine." Ibid, April, 1884. 

"Moral (Affective) Insanity." Ibid. April and July, 
1884. 

"The Curability of Locomotor Ataxia and the Simula 
tions of Posterior Spinal Sclerosis.'' Ibid, July, 1884. 

"Insanity Defined." Ibid, October, 1884. 

"The Hygiene of the Nervous System and Mind.' 
Ibid, January, 1885. 

"State Provision for the Insane." Ibid, April, 1885. 

"A Case of Psycho-Sensory (Affective or Moral) In 
sanity." Ibid, April, 1885. 

"An Outline Brief in the Management of Melancholia,' 
ALIENIST AND NEUROLOGIST, April, 1886. 

"Meconeuropathia." Ibid, July, 1886. 

"The Curability of Epilepsy and Epileptoid Affections 
by Galvanism and the Phosphated and Arseniated Bro 
mides." Ibid, January, 1887. 

"Neuritis Plantaris (A Clinical Record)." Ibid, April, 
1887. 

"Th« Scientific Rationale of Electrotherapy." Ibid, 
July, 1897. 



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NeutohiUal Progress in Awterica. 313 

"The Relation of the Nervous System to Haemophilia, 
Malarial Hematuria, etc." Ibid, July, 1887. 

' 'A Unique Case of Bi - Lateral Athetosis, " Ibid, 
July, 1887. 

"The True Nature and Definition of Insanity." Ibid, 
October, 1887. 

"The Neural and Psycho-Neural Factor in Gynsciac 
Disease." Ibid, April, 1888. 

"Essential Infantile Paralysis." Ibid, October, 1888. 

"Persistent Spasm of the Levator Anguli Scapulae 
Muscle." Ibid, January, 1889. 

"Neurological Photographs of More or Less Unique 
Cases Hastily Taken During the Active Practice of a Busy 
Neurologist." Ibid, April, 1889. 

"Over-strain and Under-power of Brain." /ftiirf, Octo- 
ber, 1889. 

"Memorandum of Examination of a Case of Neuro- 
Myotonia ('T*iomsen's Disease'), with Remarks on its Dif- 
ferential Diagnosis." Ibid, January, 1890. 

"Notes on the Legitimate Sphere of Special Medical 
Practice." Ibid, li890. 

"Note on Extra-Neural Nervous Disease." Ibid, July, 
1890. 

"Notes on the Facia! Expression of Cerebral (Multiple 
Cerebro-Spinal) Sclerosis." Ibid, July, 1890. 

"The Psychopathic Sequences of Hereditary Alcoholic 
Entailment." Ibid, 1890. 

"Virile Reflex." Ibid, 1891. 

"Psychical or Physical?" Ibid, April,' 1891. 

"Report orv Neurology and Psychiatry," July, 1891. 

"The Work of Medicine for the Weal of the World." 
Ibid, January, 1892. 

"Virile and Other Nervous Reflexes." Ibid, January, 
1892. 

"Epidemic Inflammatory Neurosis; or Neurotic Influ- 
enza." Ibid, April, 1892. 

"Medical Manhood and Methods of Professional Suc- 
cess." Ibid, July, 1892. 



jdbyGoOgle 



314 C. H. Hughes. 

"Note on the Hysterical Concomitants of Organic Ner- 
vous Disease." Ibid, July, 1892. 

"Insomnia in an Infant, with Reflections on Pathologi- 
cal Sleeplessness." IbU, July, 1892. 

"Note on Nervous Disturbances after Removal and 
Atrophy of Testicles." Ibid, January, 1893. 

"Remarks on Presentation of Diplomas to the Gradu* 
ating Class of the Barnes Medical College." Ibid, April, 
1893. 

"The Dual Action and Vicarious Function of the Cere- 
bral Lobes and Htm\'Ap\iGxes,^' American Journal of Insanity, 

i8;5. 

"Aphasia or Aphasic Insanity, Which? A Medico- 
Legal Study." Journal of Insanity, January, 1879, 

"Erotopathia— Morbid Erotism." ALIENIST AND NEU- 
ROLOGIST. October, 1893. 

"Address of the President of the Section on Neurology 
and Psychiatry of the First Pan-American Medical Con- 
gress." Ibid, October, 1893. 

"Tiie Successful Management of Inebriety Without Se- 
crecy in Therapeutics." Ibid, January, 1894. 

"Insanity in Relation to Law. Castration for Crime." 
Ibid, April, 1894. 

"Neuratrophia, Neurasthenia and Neurtatria." Ibid, 
April and July, 1894. 

"The Nervous System in Disease and the Practice of 
Medicine from a Neurological Standpoint." Ibid, July, 1894. 

"Continuous General Psychomotor Paresis (in a male) 
without the Other Concomitants of General Paresis." Ibid, 
October, 1894. 

"Psychical and Physical Sanitation." Ibid, Jan., 1895. 

"Paranoia of Cain." Ibid, April, 1895. 

"Spot Specialism — A Plea for the Treatment of the 
Entire Patient." Ibid, July, 1895. 

"Paranoia lmpot»fntia Hypochondriaca." Ibid. 

"The Nervous System in Diagnosis." Ibid, Jan., 1886. 

"A Neurologist's Farewell. Valedictory to the Gradu- 
ating Class, Barnes Medical College, 1896." Ibid, April, 
1896. 



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Neurological Progress in /America. 315 

"Scrivener's Palsy not Solely Pen Fatigue." fbij, 
October, 1896. 

"The Psycho-Neural Factor in Medical Practice," Ibid. 

"Imperative Conceptions," Ibid, January, 1897, 

"Cyclone Neuroses." Ibid. 

"Some of the Neglected and Unduly Appreciated Psy- 
chical Precursors of Brain Disease." IVeeklv Medical Re- 
view, St. Louis, June 27, 1885. 

"Bromide of Potassium and Lotions of Ether in Sun- 
stroke." Ibid, July 17, 1886. 

"The Indications and Contra- Indications of the Bro- 
mides in Practice." Ibid. March 5, 1887. 

"Insanity of Venereally induced Precocious Senility." 
Ibid, November 26, 1887. 

DR. ALLEN MCLANE HAMILTON:— "Nervous Diseas- 
es, Their Description and Treatment." Second Edition, 1881. 

DR. GUY HINSDALE:— "Syringomyelia," 1897. 

DR. JAMES G. KIERNAN:— "Katatonia." Amer. Journal 
of Imanity, July, 1877. ALIENIST AND NEUROLOGIST. 

"Trophic Disturbances in Insanity." Journal of Nervous 
and Menial Disease, April. 1878, 

"Mania Transitoria." Ibid, Oct., 1880, 

"Folie a deux." Ibid, Oct., 1880. 

"Psychoses of Secondary Syphilis." Ibid, July, 1880. 

"Insanity from Traumatism." Ibid, Jan., 1881. 

"Insanity from Sunstroke." Ibid, April, 1881. 

"Insanity from Scariatina." Ibid, April, 1882. 

"Insanity from Rheumatism." Ibid, Jan., 1882. 

"Insanity from Gout." Ibid, Jan., 1893. 

"Moral Treatment of the Insane." Ibid, Jan., 1883. 

"Moral Insanity." Ibid, Oct., 1884. 

"Feigned Insanity." Ibid, January, 1884. 

"Psychology of a Plot by the Insane." Ibid, Jan., 1885. 

"Paretic Dementia in the Negro." Ibid, Oct., 1885. 

"Race and Insanity." Ibid, April, 1886. 

"Paranoia in the Negro." Ibid, July, 1886. 

"Hysterical Accus.-itions." Ibid, Jan., 1886. 

"Art in the Insane." Ibid, April, 1892, 



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316 C. H. Hugkes. 

"The Case of Guiteau." Chicago Medical Review, 
December, 1881. 

"Medico-legal Relations of Epilepsy." Ibid, Jan., 1882. 

"Simulation of Insanity by the Insane." ALIENIST AND 
NEUROLOGIST, April, 1882. 

"Duality of the Cerebral Hemispheres." /*»<f,Oct., 1882 

"Forensic Aspects ai Folie ddeux." Ibid, Jan., 1883. 

"Paretic Dementia and Syphilis." Ibid, July, 1883. 

"Insanity from Quinine." Ibid, Oct., 1883. 

"Paretic Dementia." Ibid, Oct., 1884. 

"Paretic Dementia." Ibid, Jan., 1886. 

"School Training of the Insane." Ibid, Oct., 1886. 

"Female Physicians in insane Hospitals." Ibid, Jan., 
1886. 

"Paranoia and Human Degeneracy." Ibid, April, 1886. 

"Secondary Syphilis as a Complication of the Psy- 
choses." Ibid, April, 1887. 

"Genius Not a Neurosis." Ibid, July, 1887. 

"Paranoia." Ibid, January, 1889. 

"Insanity and Phthisis." Ibid, Jan., 1890. 

"Psychological Aspects of the Sexual Appetite." Ibid, 
Jan., 1891. 

"Lombroso on Genius." Ibid, Oct., 1891. 

"Genius Not a Neurosis." Ibid, Jan., 1892. 

"Was Carlyle Insane?" Ibid, July, 1895. 

"Nordau's Theory of Degeneracy." Ibid, Oct., 1895.' 

"Evidence of Sanity in Criminal Cases." Ibid, Jan., 
1895. 

"An Ataxic Paranoiac of Genius." Ibid, July 1896. 

"Are Americans Degenerates?" Ibid, Oct., 1896, 

"Interaction of Somatic and Psychic Disorder. Ibid, Jan., 
1897. 

"Late Epilepsy." Ibid, April, 1897. 

"Psychical Effects of Nerve Stretching." Amer. Journal 
of Neurology and Psychiaity, Feb., 1883. 

"Forensic Aspect of Attacks on Asylum Physicians." 
Ibid, Feb., 1883. 

"Insanity and Variola." Ibid, Aug., 1883. 

"Systematized Delusions." Ibid, Nov., 1883. 

"Heart Disease and Insanity." Ibid, Feb., 1884. 



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Neurological Progress in America. 317 

"Mimicry of Hydropiiobia. " Ibid, Vol. II. 

"Paretic Dementia and Life Insurance." Ibid, Vol. III. 

"Impure Paretic Dementia." Ibid, Feb., 1892. 

"Definition of Insanity." Detroit Lancet, Oct., 1882. 

"Insanity and Somatic Disease," Ibid, Nov., 1892. 

"Heredity in Insanity." Ibid, Dec, 1882. 

"Paranoia." Ibid, January, 1883. 

"Insanity from Lead Poisoning." Ibid, Feb., 1883. 

"Hebephrenia." Ibid, March, 1883. 

"Mania." Ibid, April, 1883. 

"Typhomania." Ibid, May, 1883. 

"Melancholia." Ibid, May, 1883. 

"Circular Insanity." Ibid, July, 1883. 

"Paretic Dementia." Ibid, July, 1883. 

"Sexual Inversion and Perversion." Ibid, Jan., 1884. 

"Paretic Dementia and Syphilis." Ibid, Feb., 1884. 

"Insanity," Caillard's Medical Journal, Sept., 1880. 

"County Care of the Insane." Chicago Med. Journal 
and Examiner, Nov., 1885. 

"Paranoia and Natality." Neurological Review, Feb., 1886. 

"Aberrant Manifestations of the Sexual Appetite." Ibid, 
April, 1886. 

"Psychiatry Problems in America." American Journal of 
Mental Diseases, April, 1887. 

"Insanity from Surgical Operations." Med. Standard, 
Vol. II., 1887. 

"Responsibility in Sexual Perversion." Chicago Med. 
Recorder, March, 1892. 

"Inherited Opium Habit." Review of Insanity and Ner- 
vous Disease, March, 1891. 

"Paretic Dementia and Life Insurance." Journal of the 
American Med. Ass'n, July, 1891. 

"Primary Confusional Insanity." Western Med. Reporter, 
Oct., 1892. 

"Transformed Insanity." International Med. Journal, 
March, 1893. 

||Suicide." Med. Standard, Sept., 1892. 

"Dual Action of the Cerebral Hemispheres." Medicine, 
April^^ 1894. 

'Hypnotism Fifty Years Ago." American Journal of 
Insanity, Jan., 1895. 

"Dipsomania as a Defense for Crime." Journal of Ine- 
briety^,^ Oct., 1896. 

' Epileptic Insanity." American Journal of Insanity, 
April, 1896. 



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318 C. H. Hughes. 

DR. S. WEIR MITCHELL:— A Remarkable Case of Deep 
and Long-protracted Sleep. — Transactions of the College of 
Physicians of Philadelphia, N. S., vol. iii., page 37. 

Corroval and Vao. An experimental study of two new 
poisons from the Rio Darien; by William A. Hammond, M. 
D., and S. Weir IVlitchell, M.D. Showing these to be pow- 
erful cardiac poisons, and to act on the heart muscles; dtso 
showing that the popular belief as to these wooraras, so 
called, being made active by venom is unfounded. This 
research should be repeated and an effort made to procure 
more of these poisons, which are entirely unlike woorara 
and of much interest. — American Journal of the Medical 
Sciences, vol. xxxviii., page 13. An experimental study of 
the toxicological effects of sassy bark, an ideal poison from 
the Liberian coast, West Africa; by S. Weir Mitchell, M.D., 
and William A. Hammond, M.D. — Charleston MedicalJountal 
and Review, vol. xiv., page 721. On the alkaloids of corro- 
val and vao; by William H. Hammond, M.D., and S. Weir 
Mitchell, M.D. — Proceedings of the Academy of Natural Sci- 
ences, Biological department, April, 1860, page 4, Researches 
upon the venom of the rattlesnake, with an investigation of 
the anatomy and physiology of the organs concerned, — 
Smithsonian Contributions to Knowledge, quarto pp. 1 50, 
July, 1860. 

So far as the habits, anatomy and physiology of ser- 
pents are concerned, no one has bettered this work. An 
enormous addition was made in it to venom toxicology; that 
venoms are respiratory poisons was settled by it, and the 
pathology was also much advanced; many questions of an- 
tidotes were set at rest. 

Reflex Paralysis (circular No. VI., Surgeon -General's 
Office); by S. Weir Mitchell, M.D., assistant surgeon (act- 
ing), George R. Morehouse, M.D., assistant surgeon (acting) 
and William W. Keen, Jr., M.D,, assistant surgeon, U. S. A. 
This important paper records cases of sudden palsy, the re- 
sult of wounds in remote regions of the body. 

Paralysis from Peripheral Irritation; a careful review of 
all known cases. — New York MedicalJournal, vol. n., pages 
321 and 401. 



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Neurological Progress in America. 319 

A paper on nerve injuries, with many new cases. — 
United States Sanitary Reports, Medical volume, page 412. 
pp.85. 

Contributions to the Toxocology of Snake Venoms. In- 
nocuousness of crotalus venom for that serpent, and for 
birds, etc., when ingested. This paper describes the won- 
derful influence of venom on the vessels of the peritoneum, 
and the rapid disintegration of their walls as viewed under 
the microscope. — New York Medical Journal, vol. vi., page 
289. 

On reflex spasms and palsies caused by cold applied to 
the skin of birds. — American Journal of the Medical Sciences, 
N. S., vol. Iv., page 25. 

Researches on the physiology of the cerebellum. — ibid, 
N. S. vol. Ivii., page 320, 

On certain forms of localized neuralgia accompanied by 
purpura and twitching of muscles at the seat of pain; also 
on purpura as a neurosis. — Transactions Philadelphia College 
of Physicians, N. S., vol. iv,, page 282. 

A study of opium and its derivative alkaloids. — Ibid, N. 
S., vol. lix., page 17. 

Bromic ulcers; being the first account of this symptom. 
Bromic rupia. — Transactions Philadelphia College of Physi- 
cians, N. S., vol, iv., page 347. 

Proposal to use lithium bromide; being the first intro- 
duction of this drug. It contains the largest amount of bro- 
mine of all the bromides, is very deliquescent, and there- 
fore easily absorbed, and is the best sleep- producer of all 
the bromides, and acts the most rapidly. — Ibid., page 350: 

New observations on poisoning by rattlesnake venom. 
Effects on Crustacea, insects, and on blood. — American Jour- 
nal of the Medical Sciences, N. S., vol. lix., page 317. 

Skimmed milk as an exclusive diet in disease. — Phila- 
delphia Medical Times, vol, i., pages 19 and 213. 

Arrest of the growth of nails on the palsied side in 
certain cases of hemiplegia. — American Journal oj the Med- 
ical Sciences, N. S,, vol. Ixi., page 420. 

Injuries to nerves and their consequences. The earliest 
distinct accounts of ascending neuritis and the first recom- 



jdbyGoOglC 



mendatJons as to the use of splint-rest and cold in neuritis, 
etc. 

Nail -growth in organic and hysterical hemiplegias, — 
Philadelphia Medical Times, vol. ii., page 327. 

The use of nitrite of amy! to abort epileptic attacks. 
Since then several authors have written as to this, espe- ' 
cially in England, without any reference to the origina' 
paper. — Ibid., vol. ii., page 262. 

Clinical lecture on certain painful affections of the feet. 
In this paper Mitchell first described the peculiar disease to 
which later he gave the name Erythromelalgia. — Phil- 
adelphia Medical Times, vol. iii., pageSl. 

Wear, and Tear; being hints for the overworked. For 
popular use and warning. J. Lippincott & Co. pp. 88. 

Influence of nerve lesions on local temperatures; com- 
parison of clinical and experimental results. The increase 
of heat after section is due to vascular paresis. — Archives 
{^ Scientific and Practical Medicine, vol. i., page 351. 

Cases illustrative of the diagnostic use of the ophthal- 
moscspc in iotra-craoial lesions. S. Weir Mitchell, M.D., 
sod Wm. Thomson, M.D. — Amer. Journal of the Medical 
Seienas, N. S^ vol. Ixvi., page 91. 

1. Favorable influence of long rest in bed upon the neu- 
ralgia of locomotor ataxia. 2. First to call attention to the 
fragility of bones in this disease. — Ibid., N. S., vol. Ixvi., 
page 113. 

Neurotomy. A discussion of surface distribution of 
nerves. — tbid., vol. iv., page 145. 

The supply of nerves to the skin. — Philadelphia Medi- 
cal Times, vol. iv., page 401. 

Multiple emboli in muscles, and finally death from em- 
boli in the right middle meningeal artery; left hemiplegia. 
—Ibid, page 613. 

Traumatic neuralgia; section of median nerve. — Ameri- 
can Journal of the Medical Sciences, N. S., vol. Ixviii., 
age 17, 

Headaches. A series of papers on headaches due to 
sun-heat, meningitis, over-use of sensitive or growing 
brains, and, finally, those caused by eye-strain. Up to 



jdbyGoOglC 



Neurological Progress in America. 321 

this time, the oculists occasionally record pain in the head 
as associated with defects of vision; but in no book on 
headaches were they systematically attributed to defective 
eyes. It is made clear in this essay that astigmatism, de- 
ects of accommodation, and failures in the extra>ocular 
muscles are all competent to cause headaches. — Medical 
and Surgical Reporter, July and August, 1874, page 67. 

The nervous accidents of albuminuria. — Philadelphia 
Medical Times, vol. iv., page 689. 

Post- paralytic chorea. — American Journal of the Medical 
Sciences, N. S., vol. Ixviii., page 342. 

Headaches of adolescence and the decline of life. — Med- 
ical and Surreal Reporter, vol. xxxii., page 100. 

Nitrite of amyl; its use to abort spasms; its great val- 
ue at times as a diagnostic means of discriminating between 
congestive and other states of the brain. — Philadelphia Med- 
ical Times, vol. v., page 353. 

Stumps, spasmodic disorders of. Chorea of stamps, 
etc. — Ibid., page 305. 

Spinal arthropathies. Reclamation of discovery of these 
disorders for his father, Prof. John K. Mitchell. Dr. Gull 
was usually supposed to have been the first to describe 
joint disease as due to precedent spinal lesions. Arthrop- 
athies from nerve-trunk lesions. Cases of joint-disease 
followed by spinal symptoms. — American Journal of the 
Medical Sciences, N. S., vol. Ixix., page 336. 

Rest in the treatment of disease. In neuritis, by splint, 
aided by ice, etc. Rest in spinal diseases. A study of the 
evils of rest, and how to avoid them. Record of Mrs. G. 
The earliest case of full rest treatment. — The Seguin Lee- 
tures, vol. i., No. IV. 

Notes on headaches. — Medical and Surgical Reporter, 
vol. xxxii., page 100. 

Disorders of sleep. Especially the first description of 
sensory discharges, nocturnal hemiplegias, etc. — Virginia 
Medical Monthly, vol. ii., page 769. 

Neurotomy; cases illustrating local injuries of nerves 
and their trophic consequences. — American Journal of the 
Medical Sciences, N. S., vol. Ixxi., page 321. 



jdbyGoOglC 



322 C. H. Hughes. 

Eye-strain. Headaches, vertigo, insomnia, nausea, gen- 
eral asthenia from eye-strain. Repeats the experience of 
paper of IS74, and shows how much secondary causes have 
to do with calling out the ill effects of optical defects. — 
Ibid., N. S., vol. Ixxi., page 363. 

Functional spasms, with Illustrations. — Ibid., N. S,, 
vol. Ixxii.. page 321. 

Local injuries of nerves; examination of three regener- 
ated nerves. Incomplete loss of sensation despite section 
of median and niusculo- spiral. — Ibid., page 330. 

Clinical' reports. Anemic headaches, etc. The symp- 
tom numbness. — Medical and Surgical Reporter, vol. xxxiv., 
page 101. 

Relation of pain to weather. Case of Captain Catlin. 
Invaluable and neglected information not to be found else- 
where. — American Journal of the Medical Sciences, N, S,, 
vol. Ixxiii., page 303. 

Oration before the Medico-Chirurgical Faculty of Mary- 
land on extreme measures in therapeutics. Summary of 
rest treatment, etc. Illustration of excessive bleeding. — 
Transactions of the Medico-Chirurgical Faculty oj Maryland 
for 1877. 

Fat and Blood; a method of treating neurasthenia and 
hysteria. The first effort in book form to spread the full 
knowledge of rest treatment before the profession. J. B. 
Lippincott & Co. 

■ Erythromelalgia; a rare vasomotor neurosis of the ex- 
tremities. The author here describes again more fully the 
disease sometimes called red neuralgia. With this essay it 
took its place in nosology. — American Journal oj the Medi- 
cal Sciences, N. S., vol. Ixxvi., page 17. 

Some lessons of neurotomy. — Brain, vol. i., page 287. 

Cremaster reflex; a clinical study.— Journal of Menial 
and Nervous Disease, vol. vi., page 577. 

Clinical notes on locomotor ataxia, and its hygienic 
management. — Philadelphia Medical Times, vol. x,, page419. 

The true palsies of hysteria, and the conditions simu- 
lative of this peculiar paralysis. — Ibid., vol. xxxviii., pages 
66, 130. 



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Neurological Progress in America. 323 

Lectures on the nervous diseases of women. Hysteria; 
disorders of sleep; habit chorea; chorea in the neero; epi- 
demic of chorea; relation of chorea to weather. The hys- 
terical rectum and bladder. Simulation' and dissimulation of 
disease. Second edition, 1884; Lea Brothers & Co. 

Poison of the Gila lizard (Heloderma horridum.) With 
Edward Reicliert, Professor of Psychology in the University 
of Pennsylvania. This poison rs an agreeably odorous, thin 
fluid, and is a heart poison, it causes no local effects like 
venoms. — Medical News, vol. xlii., page 200. 

Peripheral nerve lesions. — American Journal of the 
Medical Scitnces, N. S., vol. Ixxxvi., page 17. ■ 

Remarks upon some recent investigations on the venom 
of serpents, — Lancet, vol., page 94. 

Unilateral swelling of hysteria, with i3r without added 
oedema, but associated with hysterical hemiplegia or paresis. 
— American Journal oj the Medical Sciences, N. S,, vol. 
Ixxxviii., page 94. 

A physiological study of the knee-jerk and of the 
muscle-jerk evolved by a blow. S. Weir Mitchell, M.D.j 
and Morris J. Lewis, M.D. — Medical NeiOs, vol. xlviii., pag* 
es 169, 198. 

Tendon-jerk and muscle-jerk in disease. An elaborate 
study of both. With Morris Lewis, M.D. — American Journal 
of the Medical Sciences, N. S., vol. xcii,, page 363, 

Vertigo. — A System of Medicine by American Authors, 
pp. 40. 

Researches on the venoms of poisonous serpents; by 
S. Weir Mitchell, M.D., and Edward T. Reichert, M.D., 
Prof, of Physiology in the University of Pennsylvania.— 
Smithsonian Contributions to Knowledge, No. 647; quarto, 
pp. 186. 

Headaches with apparitions. This paper called out an 
interesting series of such cases, not before known to medi- 
cine, — /bid., 3d S., vol. ix., page 175. 

Spastic paralyses: a clinical lecture, — Medical News, 
vol. li., page 85. 

Facial tic, and its partial relief by the freezing spray'. 
— fbid., vol. li,, page 253. 



jdbyGoOglC 



324 C. H. Htiihes. 

Locomotor ataxia timited to the arms; cases in which 
it passes thence to the legs, reversing its usual mode of 
extension. — Ibid., vol. lit., page 428. 

Knee-jerk and muscle-jerk; a lecture. — Ibid., pafe 677. 

Aneurism of an anomalous artery, causing antero-pos- 
terior division of the chiasm of the optic nerves and conse- 
quent bi-temporal hemianopsia; a unique case of great 
physiological value, with notes by F, X. Dercum, M.D. — 
Transactions oj the j4mefcan Neurological Association, 1888, 
page 239. 

Doctor and Patient: Essays on the Physician. Con- 
valescence. Pain and Its consequences. The. moral man- 
agement of sick and invalid children. Nervousness and its 
relation to character. Outdoor life. Camp-life for women. 
J. B. Lippincott Co. pp. 177. 

IDouble consciousness. The case of Mary Reynolds. 
This woman, by nature a somewhat sad person, passed her 
life, after the age of eighteen, in alternate states of melan- 
choly or vivacity; finally living her last twenty-five years 
in her acquired or second condition of consciousness. This 
history stands quite alone in the records of this disorder, 
and contains nearly all desirable details, even to the writ- 
ing in both states of consciousness. — Transactions Philadeh 
pkia College of Physicians, 2d S., vol. x., page 366. 

An improved mode of suspension, using the eltxiws in 
place of the axilla. — Medical News, vol. Ilv., page 399. 

Treatment of Pott's disease by Professor John K. 
Mitchell's method of continual steady extension. Illustra- 
tive cases. A revival of a very useful n\eans.~~Transac' 
tions Philadelphia College of Plgrsicians, 3d S., vol. xi., 
page 82. 

Subjective false sensations of cold. An interesting set 
of unusual cases. The relation of this symptom to neu- 
ritis; gives the cases of unilateral coldness, especially that 
of Sir P, Broke. — Transactions of the American Associations, 
1889, page 12. 

A test of excessive blood-pressure. When the circula- 
tion through the temporal artery is arrested by the fmger, 
the distal end of the artery continues to pulsate; under use 



jdbyGoOglC 



Neurological Progress in America. 325 

of agents which lessen pressure this phenomenon disap- 
pears. — Medical News, vol. Ivi., page 58. 

Suspension in locomotor ataxia. Report on twenty- 
three cases, by Guy Hinsdale, M,D. ; clinic of S. Weir 
Mitchell, M.D. — University of Pennsylvania Medical Maga- 
zine, vol. ii., pane 341. 

The disorders of sleep. A very full account of the 
states the author proposes to call the pne-dormitium and 
post-dormitium, in their psychological relations to impend- 
ing insanity. Night terrors in the adult. Sleep numbness. 
Nocturnal paresis or brief paralysis. Sleep ptosis. Distress 
in limbs, or pain only on waking from sleep. Sensory 
shocks, auditory, visual, mechanical (general sensation), 
olfactory. The aura of these attacks. 

Sheep-Jerks; temporary hysterical ataxia or chorea on 
coming out of the post-dormitium, lasting from a few min- 
utes to an hour. Tonic spasm of legs after sleep. Respi- 
ratory failures in sleep; ataxic, usually seen in the prae- 
dormitium or in deeper sleep. — American Journal of ike 
Medical Sciences. N. S., vol. c, page 109, 

Unusual forms of chorea, possibly of spinal origin. 
Probably of some choreas b^ing cerebral and some spinal, 
like the canine chorea. — Transactions of the 'American Neu 
rological Association, vol. xvi., page 8. 

Sciatica, treatment by splint-rest, bandages, and ice, 
— International Lecture Series, April, 1891. J. B. Lippin 
cott Co. 

Permanent headaches. A lecture. Relations of eye 
strain to these disorders. Insufficiency of glasses for relief 
of old eye-strains, etc. — International Lecture Series. J. B 
Lippincott Co., 1891. 

Spasms, unusual forms of, evolved by voluntary activ' 
ity. Reported by Ch. Burr, M.D. — JVew York Journal of 
Menial and Nervous Disease, 1802, page 103. 

Precision in the treatment of chronic disease. Rest and 
partial rest treatment. Pain: case of life-long absence of 
sense of pain. Address before the New York Academy of 
Medicine, December. — New York Medical Record, vol. xlii., 
page 723. 



jdbyGoOgle 



326 C. H. Hughes. 

Hysterical rapid respiration; a clinical study. Diaanos- 
tic value of rapid costal type of breathing. Tracings, — Amer- 
ican Journal of the Medical Sciences, N. S., vol. cv,, page 
235. 

Undescribed form of rupia-iike skin disease in a case 
of hysteria; with comments by Prof, Duhrlng. (See last 
paper, ) Colored illustration . — Ibid. 

Clinical lessons given at the Infirmary for Nervous Dis- 
ease in 1893. Choreoid movements in adult males resemb- 
ling habit spasm — probably hysterical in origin. — Medical 
News, vol. Ixii., page 231. 

Post-hemiplegic pain. Prje-hemiptegic pain, Post-hem- 
iplegic joint disease. Joint disease limited to the side of a 
subsequent hemiplegia. Post-hemiplegic nodes. Much of 
this paper is novel, and the first description of these pain 
symptoms as related to hemiplegias and of these somewhat 
rare nodes. — Ibid., vol. Ixii., page 421. 

Hysteria, psychic anjEsthesia for touch; psychic anos- 
mia; psychic blindness in its variations, with comments. 
Clinical lessons. — Ibid., vol. Ixii., page 101. 

Erythromelalgta and Raynaud's malady, A thorough 
study of erythromelalgia, and a report of a case of absolute 
and permanent cure by nerve sections and stretching of the 
nerves of the affected foot. — Ibid., vol. Ixiii., page 197. 

Sciatica, treatment by splint-rest and bandages; with 
illustrations, etc. — Ibid., vol. Ixiii., page 7. 

Three cases of sudden mental aberration with rapidly 
developed anterior scoliosis of unusual type. Author believes 
it to be a distinct disease, not alwnys hysterical. — Ibid., 
vol. Ixiii., page 636, 

Temperature of. the extremities; differences between 
right and left feet in health; normal fall of temperature 
when erect, or when the feet are pendent. — Ibid., vol. Ixiv.. 
page 6. 

DR. HEROLD N, MOVER:— On Restraint and Seclu- 
sion in American Institutions for the Insane. 

The Brain and its Functions, and What We Know of 
it. Address. 



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Neurological Progress in America. 327 

A Case of Injury from a Strong Electric Current. 

The Nursing and Care of the Nervous and Insane, 

Clonic Rythmical Spasm of the Pronator Radii Teres. 

Periodically Recurring Ocolo-Motor Paralysis. 

Antipyrin and Acetanilid in Nervous Diseases. 

Hsematuria Simplex in a New-born Child. 

Relation of Insanity to Crime. 

Treatment of Neuralgia. 

Insanity Proceeding From the Colon, 

Pilocarpine in Pulmonary Oedema. 

Medico-Legal Relations of Shock. 

Medical Jurisprudence of Railway Surgery. 

Hypodermic Use of Arsenic. 

The Medico-Legal Relations of Abortion. 

The Nervous Sequela; of Influenza. 

The Differential Diagnosis of Uremia and Epilepsy. 

Spontaneous Recovery in Acute Arsenical Poisoning. 

Experts and Expert Testimony. 

Duty of the Profession in Inebriety. 

The Evolution of Pharmacy. Address. 

Symmetrical Hypertrophy of the Leg. 

Note on the Relation of the Sympathetic to the Cere- 
bro-Spinai Nervous System. 

Crime; Its Nature and Treatment. 

A Rare Occupation -Neurosis. 

Alcoholic Insanity as Illustrated by the Case of John 
Redmond. 

Exophthalmos Associated with Nephritis. 

Relation of Alcohol to the Inhibitions. 

Syphilis in the Etiology of Nervous Diseases. 

Reasonable Doubt and Preponderance of Evidence in 
Medical Jurisprudence. 

A Case of Neuritis Simulating Progressive Muscular 
Atrophy, Associated with Nystagmus and Increased Knee 
Jerks. 

Additional Experiences in the Hypodermic Uses of 
Arsenic. 

Tabetic Foot with Perforating Ulcer. 



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328 C. H. Hughes. 

A Case of Colchicum Poisoning. 

A Case of Chorea in Infancy. 

Progressive Cerebral Apoplexy. 

The Nervous Disorders of Typhoid Fever. 

A Case of Acromegaly. 

Akinesia Algera. 

Nystagmus. 

Catarrhal Gastritis. 

Paranoia. 

DR. JOHN K. MITCHELL:— Remote Consequences of 
Injuries of Nerves and Their Treatment, 

DR. EDWARD C. MANN:— "A Manual of Psychological 
Medicine and Allied Nervous Diseases," 1883. 

DR. CHAS. K. MILLS:— "The Relation of Infectious 
Processes to Mental Disease," American Journal of the 
Medical Sciences, November, 1894; articles in the Ameri- 
can Text-book of the Diseases of Children, edited by 
Louis Starr; "The Naming Centre," Journal of Nervous 
and Mental Disease, January, I89S; "The Localization of 
Lesions in the Pons and Pre-oblongata," International Clinics, 
vol. iii.. Fifth Series, 1895; "Some Phases of Syphilis of the 
Brain," Medical News, vol. Ixvii., 1895, page 606; "The 
Diagnosis of Intracranial Tumors," University Medical Maga- 
aiitie, March, 18, 1896; "Mistakes in Neurological Diagno- 
sis," Philadelphia Polyclinic, July 15 and August 1, 1896; 
"A Case of Cerebral Abscess Situated at the Posterior Part 
of the External Capsule," with Dr. Wm. G. Spiller, Jbwr- 
nal of Nervous and Mental Disease, September, 1886; "Cas- 
es of Aphasia Illustrating Especially Disorders of Pan- 
tomime," Philadelphia Hospital Reports, vol. iii., 1886; "A 
Series of Reports of Cases from the Neurological Depart- 
ment," Philadelphia Hospital Reports, vol. iii., 1886; and 
"Treatment of Diseases of the Brain," in the American 



jdbyGoOglC 



Neurological Progress in America. 329 

Text-book of Applied Therapeutics, edited by J. C. Wilson, 
1886. 

DR. WILLIAM OSLER:— "On Chorea and Choreiform 
Affections." 

DR. HUGH T. PATRICK:— "The Bryson Symptom in 
Exophthalmic Goitre." A study of forty cases, showing 
that the diminished chest expansion frequently found in this 
disease is in no sense pathognomonic, is of no particular 
significance as shedding light on the pathology of the affec- 
tion and is simply an expression of the general myasthenia 
that is almost invariably present. — N. Y. Medical Journal, 
Feb. 9th, 1895. 

"Course and Destination of Gowers' Tract." An 
experimental, anatomical study establishing the fact that 
Gowers' an tero* lateral tract extends as a separate bundle 
as. high as the corpora quadrigemina and then passes in a 
retrograde direction to the middle lobe of the cerebellum. — 
Jountal of Nervous and Mental Disease, Feb., 1896. 

"Hysterical Blindness and Pseudomeningitis," Journal 
of American Medical Association, Feb. 8th, 1896. 

"Diagnosis of Hysteria," especially calling attention to 
the rapid shifting of the limits of hysteric anesthesia as an 
almost pathognomonic sign of the disease. — N. Y. Medical 
Journal, Feb. 15th and 22nd, 1896. 

"Ansesthesia of the Trunk in Locomotor Ataxia." A 
study of a peculiarly distributed anesthesia of the trunk often 
found in locomotor ataxia. A symptom of very recent dis- 
covery.— M Y. Medical Journal, Feb. 6th, 1897. 

"So-called 'Spinal Irritation' ", showing that the tender 
points found in this syndrome are of psychic origin, and not 
due to any pathological condition of the spinal column or 
spinal cord, as proven by their rapid and absolute shifting. 
Read before the Illinois State Medical Association, 1897. 

"So-called Subacute Poliencephalitis, Superior and In- 
ferior, with a careful Microscopic Examination," tending to 
show that these cases may be toxic but not, strictly speak- 
ing, inflammatory, and also tending to show the intimate 
relation between asthenic bulbar paralysis and acute poliomye- 



jdbyGoOglC 



330 C. H. Hughes. 

litis. Also a suggestion as to the rational therapeusis; viz.: 
copious bleeding witli simultaneous injection of salt solution. 

Report of a Case of Syringomyelia with Trunk Anaes- 
thesia, identical in distribution with that found in tabes, but 
differing from it qualitatively. 

DR. FREDERICK PETERSON :— "The Physiology of the 
Posterior Lobes of the Cerebrum." Graduation Thesis, 
University of Buffalo, 1879. 

"A Large Renal Calculus in a Case of Acute Insanity." 
Buffalo Medical ami Surgical Journal, June, 1879. 

"Reports of Interesting Autopsies at the State and 
County insane Asylums, General Hospital, etc.," Buffalo. 
— Buffalo Medical and Surgical Journal, Sept., Nov., Dec, 
1883. 

"Reports of Two Hundred and Fifteen Autopsies." 
Ibid, Dec, 1884. * 

"Hydrobromate of Hyoscine: Its Use in Thirty -six 
Cases of Insanity." N. Y. Med. Record, Sept. 19th, 1885. 

"The Bielefeld Epileptic Colony." Ibid, April 23, 1897. 

"Morbus Basedowii." (Prize Essay Dutchess Co. Med. 
Society.) Ibid, Aug. 20, 1887. 

"Some of the Principles of Craniometry." Ibid, June 
23, 1888. 

"A Case of Arsenical Paralysis." Ibid, Aug. 4th, 1888. 

"Critical Digests on Insanity and Nervous Diseases." 
Medical Amleciic, 1888-1891. 

"Experiments with Electrical Death Currents." Elec- 
trical World, Aug. 8th, 1888. 

"Capital Punishment by Electricity." Medico- Legal 
Journal, Dec, 1888. 

"A Contribution to the Study of Muscular Tremor." 
Journal of Nervous and Mental Disease, Feb., 1889. 

"Extracts from the Autobiography of a Paranoiac." 
American Journal of Psychology , Feb., 1889. 

"Cranial Measurements in Twenty Cases of Infantile 
Cerebral Hemiplegia {with E. D. Fisher). M Y. Medical 
Journal, April 6th, 1889. 

"Electric Cataphoresis as a Therapeutic Measure." 
Ibid, April 27, 1889. 



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hieurological Progress in America. 331 

"Cephalocele." Wood's Reference Handbook, 1889. 

"Etectrothanasia." N. Y. Medical Record, Aug. ,24th, 
1889. 

"Notes on Exalgine." Ibid, Sept. Mtli, 1889. 

"A Case of Paraplegia from Gunshot Wound of Skull." 
Ibid, Oct. 5th, 1889. 

"Neuroses from Electric Injuries." Med. Analeclic, 
Nov. 16th, 1889. 

"The Colonization of Epileptics." Journal of Nervous 
and Mental Disease, Dec, 1889. 

"Paranoia in Two Sisters." ALIENIST AND NEUROL- 
OGIST, Jan., 1890. 

"Electricity as a Death Penalty." Trans. American 
Social Science Association for 1889. 

"Ichthyosis Linearis l\QutopaXh\t:n."Jounsal of Cutaneous 
and Genito- Urinary Diseases, Feb., 1890. 

"The Cerebral Palsies of Early Life," based on a study 
of one hundred and forty cases (with Dr. B. Sachs), Jour- 
nal of Nervous and Mental Disease , May, 1890. 

"A Clinical Study of Forty-seven Cases of Paralysis 
Agitans." N. Y. Med. Journal, Oct. 11, 1890. 

"Homonymous Hemiopic Hallucinations." Ibid, Aug. 
30, 1890. 

"A Second Note on Homonymous Hemiopic Hallucina- 
tions. Ibid, Jan. 31, 1891. 

"Note on the Disturbance of the Sense of Taste after 
Amputation of the Tongue." N. Y. Med. Record, Aug., 1890. 

Chapter on Insanity in Starr's "Familiar Forms of 
Nervous Disease." Published by W. Wood & Co., N. 
Y., 1890. 

Chapter on Paralysis Agitans in Starr's "Familiar Forms 
of Nervous Disease." 

"A Case of Locomotor Ataxia Associated with Nuclear 
Cranial Nerve Palsies and with Muscular Atrophies." Jour- 
nal of Nervous and Menial Disease, July, 1890. 

"A New Method of Accurate Dosage in the Cataphor- 
etic Use of Electricity." N. Y. Med. Journal, Oct. 15, 1890. 

"Further Studies in the Therapeutics of Anodal Diffu- 
sion. .V, Y. Med. Record, Jan. 31, 1891. 



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332 C, H. Hughes. 

"The Introduction of Drugs into the Human Body by 
Electricity." Philadelphia Times and Register, March 21,1891. 

"Outline of Plan for an Epileptic Colony:" N. Y. 
Med. Journal, July 23, 1892. Journal of Social Science, 
Aug., 1895. 

"The Treatment of Epilepsy." Dietetic Gazette, Aug., 
1892. Buffalo Med. and Surgical Journal, Aug., 1892. 

"Gyrospasm of the Head in Infants." Phila. Med. 
News, Oct. 1, 1892. 

"Electricity in the Diagnosis of Nervous Diseases." 
Buffalo Med. and Surgical Journal, Oct., 1892. 

"Three Cases of Acute Mania from Inhaling Carbon 
Bisulphide." Boston Med, and Surgical Journal, Oct., 1892. 

"Some Practical Points in the Localization of Spinal 
Cord Disorders." N. Y. Med. Record, Nov. 12, 1892. 

"Physiological Experiments with Magnetism at the Edi- 
son Laboratory." (With A. E. Kennelly). N. Y. Med. 
hurtial. Dec. 31, 1892. 

"Hydrotherapy in Mental and Nervous Diseases." 
Amer. Journal of Med. Sciences, Feb., 1893. 

"The Treatment of the Insane Outside of Asylums." 
Phila. Med. News, March 11, 1893. 

"The Treatment of Alcoholic Inebriety," Journal of 
Amer. Med. Ass'n, April 15, 1893. 

"Tetra-Ethyl-Ammonium: A New Solvent for Uric Acid 
Discovered at the Edison Laboratory." N. Y. Med. Journal, 
Sept. 16, 1893. 

"A Case of Acromegaly Combined with Syringomyelia." 
N. Y. Med. Record, Sept. 23, 1893. 

"A Study of the Temperature in Twenty-five Cases of 
General Paresis," Journal of Nervous and Mental Disease, 
Nov., 1893. 

"The Relation of Syphilis to General Paresis." N. Y. 
Med. Record, Dec. 9, 1893. 

"On the Care of Epileptics." Journal of Amer. Med. 
Ass'n, Sept. 30, 1893. Amer. Journal of Insanity, Jan. 1894. 

"Some New Methods and Remedies in the Treatment 
of Epilepsy." Amer. Med. and Surgical Bulletin, Jan. 1,1894. 



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Neurological Progress in America, 333 

"Progressive Muscular Atrophy and Dystrophy." Ibid, 
Warch 15, 1894. 

In Louis Starr's Text-book of Children's Diseases, 
Phila., 1894. 1. "Convulsions in Children." 2. "Infan- 
tile Cerebral Palsies." 3. "Abscess of the Brain." 4. 
"Tumors of the Brain." 

In Bigelow's International System of Electro Therapeu- 
tics, chapter on "Cataphoresis, Anodal Diffusion, Electrical 
Osmosis or Voltaic Narcotism." Phila., 1894. 

In Loomis' System of Medicine, Phila., 1897. 1. "Par- 
alysis Agitans." 2. "Epilepsy." 

"The Treatment of Epilepsy." Amer. Med. and Surg. 
Bullelin, Feb. 8, 1895. 

Eleven Chapters in the American Text-book of Dis- 
eases of the Nervous System, Phila., 1895. Subjects: 
Anatomy and Functions of the Spinal Cord, Locomotor 
Ataxia, Multiple Sclerosis, Poliomyelitis, Bulbar Palsy, 
Amyotrophic Lateral Sclerosis, Freidreich's Ataxia, Lesions 
of the Cauda Equina, Lesions of the Conus Medullaris, 
Lateral Sclerosis, Progressive Muscular Atrophy, 

"Cerebral Amyotrophy." (With Dr. J. T. Eskridge). 
N. Y. Med. Journal, March 2nd, 1895. 

"Localization of Diseases of the Spinal Cord." Atlantic 
Medical Weekly, Providence, Jan. 19, 1895. 

In Foster's Handbook of Therapeutics. D. Appleton & 
Co., New York, 1896. 1. "Rest Cure." 2. "Electro- 
Therapeutics," and other articles. 

In Household Medicine, Pub. by D. Appleton & Co., 
New York, 1896, chapter on Mental and Nervous Diseases, 

"Morbid and Automatic Movements in Idiocy and Imbe- 
cility." Amer Med. and Surgical Bulletin, July 13, 1895. 

"Craniometry and Cephalometry in Relation to Idiocy 
and Imbecility. Amer. Journal of Insanity, July, 1895. 

"Deformities of the Hard Palate in Degenerates." 
International Dental Journal, Dec, 1895. 

"Methods of Employing Electricity in Nervous Dis- 
eases." Buffalo Medical Journal, Nov., 1895. 

"The Treatment of Epilepsy." Amer. Med. and Surg. 
Bulletin. Feb. 1, 1895. 



jdbyGoOgle 



334 C. H. Hughes. 

"The Diagnosis of Lesions of tlie Lumbar Cord, Cauda 
Equina and Conus Medullaris." N. Y. Med. Journal, Way 
11, 1895. 

"The New Phrenology." /4mer. Med. and Surg. Bulletin, 
Dec. 1, 1895. 

"Colonies for Epileptics." Med. Record, Sept, 19, 1896. 
Bulletin of Amer. Academv of Medicine, Oct., 1896. 

"Notes on Some of the Newer Methods of Treatment of 
Nervous and Mental Diseases. Texas MedicalJoumal, June, 
1896. Amer. Medico -Surgical Bulletin, June 6th and 13th, 
1896. 

"The Medical and Surgical Treatment of Epilepsy." 
N. Y. Med. Journal, June 6th, 1896. 

"Vibratory Therapeutics." Ibid. 

"The Psychology of Idiocy." Amer. loumal of Insanity, 
July, 1896. 

"Idiots Savants." Popular Science Monthly, Dec, 1896. 

"The Stigmata of Degeneration." State Hospitals Bul- 
letin, July, 1896. 

"Results of Thyroid Treatment in Sporadic Cretinism." 
(With Dr. Bailey). Pediatrics, May 1, 1896. 

"Definition and Classification of Idiocy." Pediatrics, 
Jan. 1, 1896. 

"Hydrocephalic Idiocy." N. Y. Med. Journal, July 25, 
1896. 

"Microcephalitic Idiocy," 

"Paralytic Idiocy." 

"Katatonia." (With Dr. C. H. Langdon). 

DR. GEO. J. PRESTON:— "Hysteria and Certain Allied 
Conditions." 

UR. ISAAC RAY:— "Contributions to Mental Pathology." 

DR. AMBROSE L. KANNEY:— "Lectures on Nervous 
Diseases," 1888. 

DR. BENJAMIN RUSH:— "Medical Inquiries and Obser- 
vations upon the Diseases of the Mind," 1812. 

"Medical Inquiries and Observations," in four volumes, 
1809. 



jdbyGoOglc 



Neurological Progress in America. 335 

DR. WHARTON SINKLER:— "On the Palsies of Chil- 
dren." American Journal Medical Sciences, April, 1875. 

"On Lead-Palsy and its Relations to Paralysis from 
Mechanical Injuries of Nerves." The American Psychological 
Journal, November, 1875. 

"On Infantile Paralysis." The Medical and Surgical 
Reporter, Warch, 1877. 

"Cannibis Indica in the Treatment of Epilepsy." Med- 
ical Times, September, 1878. 

"Five Cases of Spinal Paralysis of the AdulL" Amer- 
ican Journal Medical Sciences, October, 1878. 

"Chorea in the Aged." Journal of Nervous and Meittal 
Disease, vol. viii., No. 3, July, 1881. 

"Two Additional Cases of Hereditary Chorea." Ibid, 
February, 1889. 

"On a Form of Numbness, Chiefly of the Upper Ex- 
tremities." Transactions College of Physicians of Philadelphia, 
June, 1884. 

"On the Different Forms of Paralysis met with in 
Children." Archives of Pediatrics, January, 1886. 

"Two Cases of Friedreich's Disease." Medical News 
July, 1885. 

"The Toe Reflex." Ibid, December, 1888. 

"On the Treatment of Painless Facial Spasm." Ibid, 
Sept., 1886. 

"IVligraine in Childhood." Transactions of the Philadel- 
phia County Medical Society, October, 1887. 

"A Case of General Paresis of Fourteen Years' Stand- 
ing." American Journal of Insanity , April, 1889. 

"Recent Observations in the Etiology and Treatment 
of Migraine." Medical News, July, 1890. 

"Diseases and Conditions to Which the Rest Treat- 
ment is Adapted." Journal of Nervous and Mental Disease, 
April, 1882. 

"On Hereditary Chorea," With a Report of Three Ad- 
ditional Cases, and Details of an Autopsy." Medical Rec- 
ord, March, 1«92. 

"A Case of Acute Spinal Paralysis; Death on the 
Twelfth Day; Autopsy Showing Transverse Cervical Mye- 
litis." Medical News, November, 1891. 



jdbyGoOglc 



336 C. H. Hughes. 

"Pathology and Treatment of Paralysis from Pott's 
Disease." Ibid, November, 1892. 

"The Remote Results of Removal of the Tubes and 
Ovaries." University Medical Magazine, December, 1891. 

"Insanity in Early Childhood." fbid, January, 1893. 

"A Case of Tumor of the Optic Thalmus." Ibid, Oc- 
tober, 1893. 

"A Case of Brain Tumor Situated in the ittotor Re- 
gion: Autopsy." International Medical Magazine, Novem- 
ber, 1892. 

"Sporadic Cretinism and its Treatment by Thyroid Ex- 
tract," Ibid, December, 1894. 

"A Case of Pott's Disease From Injury, Followed by 
Complete Paraplegia, Treated Successfully by Suspension." 
Transactions of College of Physicians, Philadelphia, February, 
1889. 

"Myxedema and its Treatment by Thyroid Extract." 
Philadelphia Polyclinic, April, 1894. 

"A Case of Lesion of the Thalmus; Death from In- 
testinal Hemorrhage." Journal of Nervous and Mental Dis- 
ease, October, 1894. 

"Three Cases of Essential Anemia in one Family — 
Father and Two Daughters." American Journal of the Med- 
ical Sciences, September, 1896, 

"Habit-Chorea." Ibid, May, 1897. 

Also articles on "Headache, Tremor, Paralysis Agitans, 
Chorea, and Athetosis." Pepper's System of Medicine, vo\. v. 

"On Polio-myelitis Anterior." Keating's Encyclopedia 
of Diseases of Children, vol. iv. 

"On Headaches and Neuralgia." Hare's System of PraC' 
tical Therapeutics, vol. iii. 

"On Chorea, Neuritis and Neuralgia." Dercum's Sys- 
tern of Nervous Diseases. 

DR, HENRY P, STEARNS:— "Insanity, Its Causes and 
Prevention." 

DR. STERNBERG'S discovery of the action* of the white 
blood corpuscles on disease germs, afterward made famous 
in Europe by Metchnikoff's researches in phagocytosis, is 



jdbyGoOglC 



Neurological Progress in America. 337 

entitled to notice, since metabolism and ptiagocytosis, because 
of the reciprocal relationship of neural and hiemic conditions, 
are intimately related to nerve center changes and conditions, 
and since nerve tone and tonic metabolism, neurasthenia and 
atonic vis-medicatrix, are naturally dependent states. 

DR. ALLEN STARR:— "The Diagnosis of Cerebral Ab- 
scess." New York Eve aiid Ear Infirmary Report, 1897. 

"Atlas of Nerve Cells." MacMillan Gr Co., 1896. 

"Tumors of the Spinal Cord." American Journal Med- 
ical Sciences, April, 1895. 

"Cerebral Tumors." Dercum's Text Book of Nervous 
Diseases, 1896. 

"Cerebral Surgery." New York Medical Record, Febru- 
ary, 1896. 

"Brain Surgery." Wm, Wood & Co., 1895. Transla- 
ted into German and French. 

"Familiar Forms of Nervous Disease." 

DR. BARNEY SACHS:— "Nervous Diseases of Children," 

DR. E. C. SPITZKA:— "Spitzka on Insanity." 

"The Relations of the Cerebellum." ALIENIST AND 
NEUROLOGIST, January, 1884. 

"The Posterior Commissure of the Brain." Ibid, April, 
1885. 

"The Relations Between the Symptoms and the Cord- 
Lesions of Posterior Spinal Sclerosis." Ibid, July, 1885. 

"How Shall the Student of Psychiatry Examine the 
Nerve Centers Post-mortem?" Ibid, October, 1885. 

DR. E. W. Saunders. St. Louis:— "Four Cases of 
Genital Reflex," ALIENIST AND NEUROLOGIST, vol. ii.. 
No. 4. 

DR. GEO. T. STEVENS:— "Eye Strain." 
DR. A. B. SHAW:— "Diagnostic Neurology." 
DR. CHAS. F.TAYLOR:— 7"iivfer's MeJicalJurisprudence. 
DR. EUGENE S. TALBOT:— 'The Eliolopy of Irregu- 
larities of the Teeih." Journal American Medical Ass'n, 1888. 



jdbyGoogle 



338 C. H. Hughes. 

"Arrest of Development of the Maxillaiy Bones due to 
Race Crossing, Climate and Soils." 1888. 

"Development of the inferior Maxilla by Exercise and 
Asymmetry of the Lateral Halves of the Maxillary Bone." 
1888. 

"Asymmetry of the Maxillary Bones." Journal Ameri- 
can Medical Ass'n, 1888. 

"The Alveolar Process." Journal American Medical 
Ass'n, 1888. 

"The. Origin and Development of the V and Saddle 
Arches and Kindred Irregularities of the Teeth." Journal 
American Medical Ass'n, 1889. 

"Statistics of Constitutional and Developmental Irreg- 
ularities of the Jaws and Teeth of Normal, Idiotic, Deaf 
and Dumb, Blind and Insane Persons." Dental Cosmos, 1889. 

"Studies of Criminals." ALIENIST AND NEUROLO- 
GIST, 1891. 

"Evidence of the Somatic Origin of Inebriety." Jour- 
nal of Inebriety, 1891. 

"Stigmata of Degeneracy in the Aristocracy and Reg- 
icides." Journal American Medical Ass'n, 1894. 

"The Degenerate Ear." Journal American Medical 
Ass'n, 1896. 

"Degeneracy of the Teeth and Jaws." Journal Amer- 
ican Medical Ass'n, 1896. 

DR. E. H. VAN DEUSEN:— "Observations of a Form 
of Nervous Exhaustion (Neurasthenia) Culminating In In- 
sanity, 1867. 

DR. S. G. WEBBER:— "Treatise on Nervous Diseas- 
es," Boston, 1895. 

DR. W. S. WATSON:— "Habit, its Forms and Phas- 
es." Medical Progress, Sepicmbi^T, 1891. 

"Tlie Early Recognition in the Mentally Disturbed," 
read in the Neurological Section of the American Medical 
Association, Baltimore, 1)J85, urging the importance of rec- 
ognition of the Initial symptoms and the avoidance of asso- 
ciating the slightly disturbed with the truly degenerate 
class and the importance of relieving the intestinal sluggish- 



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Neurological Progress in America, 339 

ness, unloading the prima vivje if we would intercept auto- 
inoculation and its consequences. 

"Opium Inebriety." Neurological Section American 
Medical Association, 42nd Annual Meeting. 

"Electric Light as a Therapeutic Agent," Paper before 
the American Electro- Therapeutic Society in Boston, Sep- 
tember, '96." Claiming that the different rays of light 
eminating from the electric light have a chemic effect pe- 
culiar to itself, the physiological action not as yet freely 
understood. 

"Electrolysis." A Paper in the Neurological Section of 
the American Medical Association, Baltimore, 1S95. 

"Opium Addiction." A Paper in the Neurological Sec- 
tion American Medical Association, Newport, June, 1889. 



jdbyGoOglc 



THE LIMITS OF PSYCHOLOGY. 



Extract* from the Inaugural Address of the Academic Year 
1896-1897. 

By PROFESSOR EUGENIO TANZI. , 

THE current philosophy of pantheism and of spiritualistic 
monism, the conception of the world as will and rep- 
resentation — the unhappy nucleus of a system not devoid of 
genial modernity — the animism not yet formulated but already 
active, of William Wundt, and the seductive theory of 
unconscious cerebration, prelude to the absurdity of an 
unconscious psyche, have prepared the soil for panpsychism, 
creating innumerable misconceptions in regard to the signi- 
ficance of intelligence which tends to become lost in the 
undeterminateness of a metaphysical abstraction. A physi- 
ologist, Pfluger, claims there is consciousness in the spinal 
cord of a decapitated frog. Then the protisti are discovered 
and to them also is assigned intelligence, certain of their 
automatic reactions with a semblance of spontaneity being 
interpreted as voluntary. Science teaches daily in chem- 
istry and physics how very small differences in cause may 
give rise to great differences in effect, and how, from a 
simple isomeric dislocation of atoms may arise new proper- 
ties in the molecule, which is the seat and object of them. 
The formula of struggle for existence understood as a con- 
scious and active combat of all living things, individuals and 
species, one against the other, becomes a coefficient to the 
universalisation of mind, because, applied unreasonably it is 
made to serve to define the fatal biological relations existing 
between pluricellular organisms, on the one hand, and 

TransJated by Dr. SuMona P, Borl*. Toronio, Ciintdii. 

[340] 



,db,GoogIc 



The Limits of Psychology. 341 

pathogenic micro-organisms on the other, so that, in the 
white blood corpuscles, under the warrior guise of phago- 
cytes, and in the bacteria as assailants, we are required to 
see so many intelligent combatants engaged in a voluntary 
warfare. The metaphor is pernicious; it entered into scien- 
tific circulation as a word, and has remained as an idea, and 
we find the picturesque simile of a war, chosen wisely by 
Charles Darwin, assuming in the impatient fancy of his 
followers, the exact value of a universal formula. 

And in the same way panpsychism has been turned from 
the trenches of theoretic philosophy into a domain of its 
own, under the guise of popular science. We find a phy- 
siologist, Hering, attributing memory to muscles; and bot- 
anists, scouting the healthful examples of Charles and 
Francis Darwin, interpreting as acts of sensibility, choice 
and will, certain reactions of vegetable organisms, which 
certainly do not show the faintest spark of consciousness. 
And the will, which can only in the abstract be separated from 
sensibility and intelligence, becomes a synonym of energy, 
so that, even were we deprived of consciousness of the act, 
and prevision of its aim, we should still have its proper 
determining characteristics, and, it may be, even more than 
these. 

The progress in the study of the protisti, making known 
certain peculiarities of their lives due to the action of nat- 
ural forces such as gravity, sunlight, electricity, chemical 
allinity and contact with solid bodies, while they prove always 
more forcibly the universal empire of mechanics, on the 
other hand, by the very abundance of the facts collected, 
and the great multiplicity of their mechanical causes, per- 
mit under the impression of surprise and almost admiration, 
of seeing in certain reactive movements, the manifestation 
of intelligent will. The railway train which passes swiftly 
along impelled by an internal force, and the comet whose 
appearance was foreseen and is verified, represent the one 
a triumph, the other a confirmation of mechanical laws, 
though to the savage who does not understand them, they 
nourish the superstitious mysticism of which they are a 
direct confutation. On this misapprehension was founded 



jdbyGoOglC 



342 Eugenio Tanii. 

the old idol of vitalism which with the convenient vital force, 
was successful in solving in an instant all the problems of 
physiology, either pretending that they were resolved mys- 
tically, or proclaiming them irresolvable mechanically; in 
both cases scientific research, being either superfluous or 
insufficient, lost a great deal of its value. 

Then the habits of the arthropoda studied with a new 
vigor from the Darwinian standpoint, succeeded if not in 
inventing more, at least in exaggerating the intelligence of 
these animals, and in strengthening illusions concerning that 
of the lower animals. Also historical studies, being modelled 
on the theory of evolution, and abusing the analogical 
method, tended to regard society as an organism endowed 
with a mind of its own, to which were assigned laws and 
organs. The arts have not escaped the contagion and in 
pictures and literature we find symbolism flourishing. 

In order to destroy modern panpsychism from which 
have been evolved these philosophic theories, these scien- 
tific chimeras, these literary omens — to clear the air of this 
cloud which obscures truth, we must decide from a scienti- 
fic point of view exactly where intelligence begins and where 
it ends; that is to say in what consist its required condi- 
tions and what are its limits in the living world and in the 
universe. 

All psychic phenomena are reduced to sensations or to 
conscious distinctions. Mill truly says that there is in psy- 
chology only one fact, sensation; only one law, association. 
This principle holds good not only for concepts but also for 
the emotions, which are facts built from the same materials 
and naturally it is applicable also to the will, inasmuch as 
this is the prevision of a concept, as desire is the forerunner 
of the emotions. Without these elements already very 
complete we can imagine only the semblance of conscious- 
ness. A sensation must exist in the consciousness; other- 
wise it might be presented as light, sound, mechanical force, 
a chemical phenomenon, a biological fact, or as chemical or 
physical energy itself, this being made possible by the 
reciprocal convertibility of energy, but it would still not 
be a sensation. Unconscious sensations, unconscious psychic 



jdbyGoOglC 



The Liir.ils of Pf,ycholo£v. 343 

activity, says Ardigo, are contradictions in terms wtiicti lead 
to the strangest errors. 

Now, since sensation exists in the consciousness it is 
necessary tliat it be able to individualize among a crowd of 
other sensations and especially among similar sensations, or 
in other words, that it assumes the form of a distinction. 
This takes place as the result of a confronting event in 
two ways, either among different sensations which awaken 
the consciousness simultaneously, or from different sen- 
sations modifying the consciousness successively. In the 
first case the consciousness is multiplied into so many 
simultaneous sensations, '.which are more or less clear, and 
we have a mosaic of partial consciousnesses; in the second 
case it is transferred en masse from the sensation which 
loses sight of it (but the memory remains) to a successive 
sensation and we have a magiclantern slide of general 
consciousness. In the latter, as in ihe former, the conscious- 
ness differentiates, assumes a special state, i.e., liistiitguislics 
— and it distinguishes objects only inasmuch as it feels in 
different ways. This, its special and necessary faculty, the 
consciousness would have no means of exercising were it 
not that it possesses in itself some elements of variety. 
The external world is the perennial source of this variety, 
either because it projects its different energies on the body, 
which receives them in all its parts, or, because in the 
vicinity of the. body, it acts incessantly and successively, 
hi fact, though it seems almost superfluous, we may say 
that the mind is sheltered always by a body which has an 
extension into space and a duration in time. 

The necessity that the elementary terminus of the 
psychic fact shall be distinction, springs from the biological 
office which belongs to the functions in general of an organ- 
ism, the utility of the individual or the species, and in the 
particular case of psychic processes, consists in the veritJcu-' 
tion of a systematic correspondence between internal phan- 
tasms and external realities. Thus there arrive at the con- 
sciousness, the necessary conditions for those practical and 
supreme manifestations of intelligence, the voluntary actions. 
This systematic correspondence between what goes on out- ■ 



jdbyGoOglC 



344 Eugenia Tan^i. 

side of us, and that which takes place within us, is not 
merely a particular instance of adaptation, it is the great 
animating and perfecting law of life. It is a passive adap- 
tation inasmuch as intelligence Is representation and feeling: 
and active in that it is manifested by the will which is cap- 
able of modifying to our advantage our environment, but 
which, in so far as it demands consciousness of the act and 
prevision of determinate and desired consequences springs 
passively and necessarily from an accumulation of distinc- 
tions, sometimes indeed from a conflict of them. 

If the correspondence between the subjective and 
objective be lacking, all the long series of visions and 
actions which constitute, between birth and death, the cycle 
of a psychic life, would be reduced to a dream devoid of 
analogy with the real world; man himself, a pilgrim with- 
out a destination would traverse reality as if asleep, carry- 
ing On his back a burden of pure illusions. If, however, the 
correspondence were there, but without the characteristics 
of regularity or constancy, the psychic processes would con- 
stitute so fallacious a guide, so poor an armor for life's 
battle, that it would be only an additional risk, a sign of 
weakness, a monstrous function, the apparition of which in 
philogenesis and ontogenesis would have no biological reason 
and would conduce to a fatal inaptitude fur life. A slight 
aberration from this correspondence, insanity, leads to sep- 
aration from society and extinction of family. 

Thanks to this superior adaptation we are able to rec- 
ognize things for what they are and at their true value, to 
classify similar objects and separate dissimilar, arranging 
them in a logical sequence which is neither a copy nor a 
literal translation of the real order, but takes into consider- 
ation the intercurrent objective relations between external 
phenomena, in order to register them in a certain way, and 
according to certain laws, as the subjects are arranged in a 
table of contents. In fact, in every intelligent act there 
intervenes, besides the sum of the actual impressions, also 
a certain number of simultaneous and successive impres- 
sions, of internal origin, which are the products of previous 
experiences, and which, awakened by the arrival of an 



jdbyGoOglC 



The Limits of Psychology. 345 

actual impression, join with it to form an act of perception 
or of recognition. Besides those qualities which we really 
see in an object, there are those which we do not perceive 
but divine by virtue of memory and experience. In other 
words the intelligence is not a mere mirror, neither is it an 
automatic safe. External occurrences are not transmitted 
directly to the consciousness, but are first subjected to a 
process of elaboration, i.e., to an analysis and a synthesis. 

In what does the analytic examination consist.' The 
organism collects from objective phenomena some minuti^ 
which objectively are differences, and subjectively become 
distinctions. Thus from numerous distinctions we can rec- 
ognize {in the case of a cap for instance) the existence of 
a multitude of differences, or of a new object. Position, vol- 
ume, consistency, weight, form and color would not be 
sufficient to make us recognize in that object a human 
head-covering were it not that at the sight of it pale mem- 
ory opportunely recalls the numerous and varied caps we 
have seen during our life, and that it responds promptly, 
constantly and systematically to the call of each newcomer 
and this fusion of similar mnemonic images with actual 
impressions, determines the synthetic reconstruction which 
from a dark-cotored, round, light, felt object, large as a 
head, and attached to a peg, permits us to recognize a cap, 
because it is presented to our consciousness not only with 
the few attributes immediately perceived by our senses, but 
also with many others already known, and more character- 
istic, as they connect and complete it by the generic 
attributes which they instantly furnish, called forth from 
memory's archives. 

The organs of sense constitute the analytic apparatus, 
the central nervous system, (brain and ganglia) the 
synthetic. A mere nothing — a swinging pendulum suffices 
to set in action, sight, hearing and muscular sense, each 
bringing in its train a throng of varied differences, which in 
their turn give origin to a multitude of distinct sensations, 
that crowd the shadow army of mnemonic phantasms. 
If, however, the phenomenon presented to us, is something 
more, if it is, for instance, the person of some one we know, 



jdbyGoOglC 



346 Etigenio Taiiii. 

tlie impressions produced are innumerable {sensory, repre- 
sentative and emotional) provoked by his present appari- 
tion and re-evoking past appearances. All this is only a 
work of integration, constructed from analytic data, direct 
and indirect, which are furnished by the sense; the direct 
are drawn from the object at once, the indirect (memory) 
from other objects and more or less similar occasions. The 
syntheses are the wider and more elificacious, as the number 
of indirect analytic data increase while the direct are limited 
by the material reality of the object and the capacity of 
our senses. 

Until now we have considered the Intelligence without 
regard to the living organism which is its real and insepar- 
able atmosphere or at least the only one in which we see 
it operate. In order to judge correctly we must take into 
consideration the organic conditions which render distinc- 
tions possible. Since, from a subjective point of view, 
iiisliiiciion requires as a necessary condition the establish- 
ment of multiple, precise and constant relations between 
the various sensations, so that an isolated distinction is 
impossible, so from the objective point of view, the dyna- 
mic proces5es which constitute its substratum mu.st present 
the same characters of multiplicity, precision and constancy; 
nor will they give origin to distinctions it tliey be simple, 
inexact or inconstant. External actions, in order to be rec- 
ognized as different, or in order to become internal differ- 
ences, must provoke different dynamic processes. These 
dynamic processes, numerous and simultaneous as the 
external phenomena, and the differentiation of which pro- 
ceeds pari passu with the onto-philogenetic development of 
the organs of sense, must flow into a more or less exten- 
sive central basin and there assume well-defined respective 
positions, so as to permit a definite combination between 
the elementary dynamic processes. 

But, in order that all this may occur, that is in order 
that the elementary dynamic processes may preserve their 
I'roper individuality, they must reach the centre by separ- 
ate paths, A system of centripetal paths is necessary, 
along which, if they are numerous and close together, we 



jdbyGoOglC 



The Limils of Psychology. 347 

can postulate the theory of isolated transmission; further 
the actual dynamic processes in order to accomplish the 
identification of objects, must join innumerable and varied 
other traits, the remains of antecedent processes, and, 
hence it is necessary that these latter shall have behind 
them something definite, durable and localized either in one 
place or in an extensive system of central receivers. And 
these central receivers, open to dynamic processes which 
the senses bring to them incessantly on all sides, must 
possess the power of changing other dynamic processes 
with these receivers — near and far — which are not employed 
in the act of distinction, but which, awakened by the col- 
lateral commotion, aid the actual distinction with a similar 
series, more or less long, compact and vivacious of mne- 
monic distinctions. 

All these conditions, without which the psychic activity 
could have been only riidimentarily developed, are found 
realized only in the nervous system. There we find the 
fasciculi abundant, the fibres numerous whether it is the 
canals which carry to the consciousness, sensorial impres- 
sions or which discharge voluntary actions to the muscles; 
and like knights, there stand between the centripetal fibres 
of sensibility, and the centrifugal of motility, the receivers, 
viz.; the nerve cells. 

The physiological action of external energy, the object 
of consciousness is favored by the different structures which 
the nervous system assumes in the organs of sense and 
wherever the surface of the body is exposed to external 
changes. Each of these structures, differing widely from 
each other, is extraordinarily appropriate for a given pur- 
pose, is very circumscribed in energy, reacting differently 
to the slightest variations in that kind of stimulus, but 
remaining mute and inert to all others; ror light we have 
the rods and cones of the retina, exquisitely sensitive to 
the chemical influence of various colors, and extended over 
a large surface like a photographic plate; for sound the 
ciliated cells of Corti, prompt to vibrate in unison to varicus 
notes, and probably graded in dimensions like a musical 
instrument; for touch, simpler terminations of fibres with- 



jdbyGoOglC 



348 Eugenio Tanii. 

out cells, just sufficient to respond to quantitative differences 
in compression. 

Where the fibres are very closely packed and crossed, 
distinct transmission along these paths of distinction is 
secured In more highly developed organisms by an isolat- 
ing substance, the myelin, which sheaths the functionating 
and conducting axis>cylinder, as do the turns of silk round 
an electric wire. But this is not enough; among the ele- 
ments of the central nervous system we find, in vertebrats, 
a new sustaining and isolating tissue, which becomes more 
and more perfect as we ascend in the scale of life and 
intelligence, viz.; the neuroglia. Composted also of fibres and 
of cells which are characteristic in form, and which in micro- 
scopic investigations can be stained independently of the 
nerve tissue proper, this tissue although extraneous to the 
psychic processes, is not without relations to them, inas- 
much as it seems to trace out the paths for the nerve fibres, 
which from the dawn of life develop in definite directions, 
and with a determinate goal; it winds round the nerve 
celts as if to protect them from injury, and, above all, to 
prevent dispersion of energy, and acquiring here a delicacy 
in its corpuscles and a peculiar ramification of fibres which 
is not found in that which surrounds the nerve fibres. 

In order to better individualize the objective differences 
which the intelligence must translate into distinctions the 
nervous system is not only divided into fibres for separate 
transmission, but each fibre, and the essential part of each 
fibre, the axis-cylinder, is subdivided into fibrils. This 
fibrillar structure, prophesied by Max Shultze and to-day 
verified by others with the same methods, continues into 
the protoplasm of the cell, which therefore seems suscep- 
tible to partial stimuli, capable of deviating in various ways 
the nerve wave which arrives, traverses, and is discharged, 
transformed. 

While this delicacy of microscopical subdivisions, com- 
bined with, a rigorous separation between nerves, fibres and 
fibrils, as indeed between different portions of the same 
cell, demonstrates that extreme precision of connections 
which is required for the exact and distinct localization of 



jdbyGoOglC 



The Limits of Psychology. 349 

the innumerable dynamic processes which correspond to the 
indeterminate numt>er of our representations, on the other 
hand the fine feathery branches of the nerve cells, the col- 
lateral fibres which arise at short intervals from an axis- 
cylinder, and the bundles of associated nerves connecting 
distant cells, appear to be for the purpose of rendering 
possible that multiplicity of anatomical relations which we 
have established as another of the necessary factors of 
intelligence. Its processes, analytic as they originate from the 
objective reality, and synthetic at the moment that they 
take conscious form, comprehend whole constellations of 
cells, and pass, not only from cell to cell, but from system 
to system, in graven combinations, and microscopically are 
most extensive — a kaleidoscope of intelligence.' The most 
careful localization of single processes is not hindered, on 
the contrary is rather aided, by the rank abundance of the 
fibres and cells, because the abundance of the elements is 
counteracted by their minuteness and most exact relations. 
This harmony of the morphologically small and the numer- 
ically great is without a parallel in any other tissue, includ* 
ing the connective where the fibres and cells live, if not in 
nutritive, certainly with much functional autonomy. The 
association, not in casual continuity, but as a systematic 
union between near and distant elements with intermediary 
expansions, and evidently designed to maintain a functional 
solidarity, is a property characteristic of the nervous system. 
At this point we are brought face to face with another 
problem. Is this systematic association, the anatomical basis 
of intelligence, a general attribute of the nervous system in 
all its parts and throughout all its forms? We answer 
promptly no. The spinal cord has no consciousness, nor is 
it true that echinodermata and coelenterata possess it. The 
biological end of the nervous system as a whole, as of 
every other organ indeed, is not consciousness alone, but 
simply and principally utility, or the preservation of the 
organism, which aim may be attained without intelligence or 
consciousness, in life's daily battle the survivors are the 
fit or the fitted, those, namely, who have had the fortune 
(rarely indeed the prudence) to conform to the changing 



jdbyGoOglC 



350 Eugenia Taii^i. 

conditions of their environment. Selection between the 
fit who survive, and the unfit who succumb, perpetuates, as 
is known, the advantageous adaptation of certain stable 
formations, which become characteristics of the species. 
Among these formations is the nervous system, inasmuch 
as it is rendered capable of responding to external events 
by adequate and advantageous reactions which assume the 
form of movements, being drawn towards favorable agents 
and repulsed from hurtful influences. In the evolution of 
the nervous system this organization is at first of the 
simplest; to a given stimulus and only to that, there succeeds 
a certain reaction. For this consciousness a system of 
association is not at all necessary. It is sufficient that 
a group of cells or neurons as we shall call them, 
anthropomorphically sensitive, receptacles of mechanical 
or chemical force in a state of tension,- should be 
distributed throughout the external tegument, and that 
the terminations of these be applied to a group of motor 
neurons, and we have those simple and unconscious move- 
ments of retraction and prehension, of flight or approach, 
of which the animal stands in need for purposes of self- 
preservation and nourishment. When the accumulation, in 
time and space, of external events always becoming more 
varied, demands more and more adequate adaptations, or 
more differentiated and numerous reactions, the organization 
of the nervous system becomes multiplied and complicated, 
giving origin to so many special meclianisms, that one acts 
without the knowledge of others, and ignores them. If, 
however, the special mechanisms continue to increase, they 
must cease to be separate and autonomous, and there will 
become necessary the formation of a single governing organ, 
general and cornpJex. The function of this mechanism will 
be the resolution of different external events, which are so 
many problems presented to it, no longer answering by stereo- 
typed reactions but with responses which vary answering ac- 
cording to circumstances, bringing into co-relation, and, as it 
were, sitting as arbiter between the special mechanisms. 
Economy of space renders the formation of further new 
special mechanisms impossible; a similar multiplication, in 



jdbyGoOglC 



The Limits of Psychology. 351 

order to meet increasing needs, would never end and 
would finally lead to encumbering the organism, to the pre- 
judice of other organs and tissues which are still more neces- 
sary to life. Economy of time renders quite inadequate 
to needs which are not only becoming always more incessant 
and numerous, but which are changing and ever new, a 
series of mechanisms which must be formed slowly and 
from time to time in onto*genesis and philo-genesis, and 
which respond each by a special reaction to a specified 
agent. In order then, not to be overcome by the number 
and novelty of the stimuli, the organism must possess a 
central mechanism, to which shall flow impressions of ex- 
ternal agents, and from which can be diffused opportune 
reactions, even to unusual combinations of stimuli. And 
thus are provided for the new situations: thus are impro- 
vised those attacks and resistances, which arise from the 
programme of a biological automatism; thus the unexpected 
is overcome. In place of an interminable procession of 
special adaptations and habits we have a general adapta- 
bility with occasional adaptations ; in place of complete 
equipment of relations restricted to given external actions 
and certain nerve reactions, we have a system of indefinite 
relations between an always augmentable number of ^- 
ternal actions and an increasable number of compiicatable 
nervous reactions, that are the result of a conscious dis- 
crimination, the object of an intelligent prevision and the 
equivalent of a voluntary determination. This perfecting 
of the nervous system, inasmuch as it unifies reactive adap- 
tations into a systematic adaptability, having its seat in a 
very complex central organ, conduces necessarily to intelli- 
gence. In fact, the intelligence is the product of functional 
evolution from specific to systematic reactivity, and organic 
evolution from small disseminated centres to one unifying 
centre. This superior organization of the nervous system 
does not preclude the usefulness of reflex action. We have, 
on this account, therefore the reason of the co-existence in 
the higher nervous system of inferior centres for reflex ac- 
tion, and superior for distinction and conscious determina- 



te! byCoOglc 



352 Eugenia Tanji. 

tion; an automatism which vegetates and prospers aside 
from intelligence. 

If now we examine the structure of the nervous sys- 
tem in its various parts, as also in its philogenetic grada- 
tions, we must recognize, that the conditions demanded for 
the carrying out of conscious processes, can only be real- 
ized in the higlier forms. In the domain of the sympa- 
thetic nerve, the relations between cell and cell, between 
neuron and neuron, are almost individualized; pericellular 
tufts exist, including only one element. In the spinal 
cord the neurons which we, in a rather arbitrary manner, 
term sensory, give off, it is true, a large number of collat- 
eral filaments, but each of these is placed in relation with 
a determinate number of motor cells, and gives origin, if 
not to one only, at least to only a very few types of reac- 
tion, which take a certain definite course and have a spe- 
cial effect, both of which are very simple. In the cere- 
bellum itself we find also nests around the cells and 
other affirmations of simple relations between neuron 
and neuron. Besides, the connections between the various 
cells assume a geometric regularity; in the sagittal plane 
there expand like a fan, very exactly, the string of cells of 
Purkinje and the small flattened cells of the molecular lay- 
er; the prolongations of the granules run parallel to each 
other as regularly as telegraph wires in the transverse plane, 
which is exactly at right angles to the preceding, occupy- 
ing an entire lamina of the cerebellum. 

How different is the structure of the central organ par 
excellence, the cerebrum, studded with cells in great number 
and apparent confusion, like the stars in the vault of heav- 
en, they present the most complicated relations in every 
sense, and have no geometrical arrangement. The pyramid- 
al cells, with their luxuriant aborescent branches provided 
with small spines which have been known for some years 
but only of late have been recognized as morphological en- 
tities, probably as elementary collectors of the stimuli which 
act on the cells, stand surrounded by a most intricate net- 
work of nerve terminations belonging to the sensory fibres 
of projection or to the eminently psychical fibres of associa- 



te! byCoOglc 



The Limits of Psychology. 353 

tion, which connect the various parts of the brain and in 
the human cerebrum form a very important part of it — a 
system of intercellular communications extending to great 
distances, from convolution to convolution, lobe to lobe, and 
hemisphere to hemisphere. This plurality of relations is 
not weakened by the microscopic intervals which, in every 
part of the nervous system, divide one neuron from anoth- 
er, each maintaining an anatomical individuality; it is 
known that the current or dynamic processes passes with- 
out any cessation, across these minute intervals, which in- 
deed are far from condemning these nerve elements to a 
functional isolation at all resembling inertia. These lacunx 
probably form the means by which is made possible the 
gradual anaplastic approaches between the neurons, thanks 
to which, we can explain clearly both the slow progressive 
organization and the continuous and indefinite perceptibility 
of the intellectual functions. 

The progressive diffusion of the nerve processes in the 
territory of the nerve centres, is proved in the optic system 
of fibres. Here the single rod of the retina which has col- 
lected its microscopically small fasciculus of luminous rays 
and carries them to the sensorial cells of the visual centre, 
passes by a series ot neurons, which increase in number 
as we proceed from the periphery towards the centre, in 
other words forming a cone, the apex of which is at the reti- 
na, and its base the cerebral vault. The elementary pro- 
cess which spreads itself twtween the imaginary walls of 
this cone, has very aptly been likened to an avalanche; it 
would have remained a simple heap of snow had it not en- 
countered the world of cerebral neurons. From more to less 
is the common law of all sensory life, small at first, it is 
large at its termination in the central organ. Thus the 
vault of the cerebrum contains in its vast superficies, the 
projections of the retina and the auditory organ, and the sen- 
sory nerves of the skin, or, in other words ,it contains a sec- 
ond skin, ear and retina. And each of these projections, 
similar in structure and passing insensibly into each other, 
results from other fairly extensive partial projections, which 
correspond to the very minute morphological elements of 



jdbyGoogle 



354 Eugenia Tan^t. 

which the sensory apparatus at the periphery is composed ; so 
that while the morphological elements are arranged in lines 
the one outside the other, as in the retina and ear, or scat- 
tered throughout the skin, tongue and nasal mucous membrane ; 
as is demanded by their analytic office, in the cerebral cortex 
it is entirely different. There the partial but wide projec- 
tions on which are discharged the elementary avalanches of 
each sensory process, are arranged like the circles made by a 
stone dropped on the surface of the water. Each of the circles 
has points in common with the others and none, except 
those un the outside, possesses a single point which is entirely 
its own; each circle has nevertheless a precise and mathe- 
matical individuality, nor would there be any reason for 
mistaking it for any other. 

It happens in consequence that each cell of the cere- 
bral cortex belongs at the same time to several partial pro- 
jections, or is situated in a system of cones which are 
partially coincident and the bases of which, more or less 
promiscuous, guard at the same time many apices, many 
rods, ciliated cells or sensory endings in the skin. A single 
cerebral cell is the prey at the same time of many accum- 
ulated impressions from all of which at once, as it scintil- 
lates with their attrition issues the act of distinction. 

In this complexity, not so much of elementary form as 
of relations, in this intensity of life which it derives not 
from the wide extension but from the simultaneous over- 
lapping of the processes which come crowding in, and give 
place to conscious elementary distinctions, each of which is 
the result of much component energy, in this we see the 
whole physiological mechanism of intelligence. Therefore 
this highest function of the nervous system is possible only 
in the cerebral cortex or in ganglia similar to It in central- 
ity and structure. 

If consciousness cannot exist in organs so complicated 
and centralizing {accentratoii) as the spinal cord, the ganglia 
of the sympathetic, and, we do not hesitate to say, in the ana- 
logues of these in many invertebrates, how is it possible to 
imagine it in the lowest of the coelenterata protozoa, or 
worse still in the protisti? How, in spite of a few empty 



jdbyGoOglC 



The Limits of Psychology. 355 

appearances, can we suppose it to be present in plants? 
Modern studies on unicellular organisms and on the mobile 
cells of the metazoa, not only prove the direct efficiency of 
physical and chemical agents such as light, gravity, elec- 
tricity, and reducing substances on their movements, but 
teach irs the way to reascend to a mechanical interpretation 
of the human mind. 

As to other living beings the arthropoda show a certain 
intelligence because they are provided with good sensorial 
organs and cerebroid ganglia, where there take place s.ome 
unifications of nerve processes, but the type of such intel- 
ligence differs widely from ours. In bees and ants the 
extraordinary specialization issuing from useful reactions, 
has rendered superfluous or perhaps has impeded the farther 
development of the cerebroid ganglia; the richness of the 
reflex automatism has condemned the intelligence. These 
primates of insect, life are not further perfectible because of 
their kind they are too perfect, and have stopped at a crys- 
tallized grade of intelligence, in which can flourish only a 
semi-automatic and unvariable activity, a kind of Chinese 
civilization. The cephalopod mollusks, endowed with highly 
developed sensory organs and cerebroid ganglia, but with a 
minor predominance of the reflex centres, are less perfect 
but more versatile, less developed as to offence and defense, 
but with a more decided tendency to a further development 
of nerve organization, indeed to intellectual progress, of 
which they are themselves a good example in comparison 
with the lower orders of their zoological group. On the 
other hand in echinodermata with their incomplete ring 
of simple and ill-connected ganglia, consciousness does not 
exist at all, and we are compelled to smile when in the 
reflex act of the asteria, which, one of its five segments 
being seized by the- enemy, detaches it at the point of 
articulation and thus saves the rest of itself from death, 
the fancy of scientists recognizes a voluntary auto-mutila- 
tion or. When it is dismantled of all its segments, a suicide. 

Not for nothing do the neurons, ramifying so richly in 
the human cerebrum, decrease and become more simple as 
we descend in the animal kingdom, until in the lowest 



jdbyGoOglC 



356 Bugenio Tanii. 

species, as in worms, we lose all trace of fine nerve branch- 
ings. Nor is it for nothing that there is arranged in verte- 
brates, among the chief points of the sensory nerves, a 
web of indirect communications, which, with the paths of the 
cerebral cortex reciprocally prevents, for instance, the isolation 
of the geniculate bodies and the acoustic tubercles; with- 
out this we should lack consciousness of distinction between 
such different classes of sensation as light and sound, and 
the intelligence would be in an altogether rudimentary 
state. This same uniformity and continuity of structure 
throughout the wide expanse of the cerebral cortex, dem- 
onstrates well its synthetizing office. Intellectual evolution 
consists then of conservation with the gradual formation of 
a centralizing nervous organ. And if we extend the signi- 
fication of the formula so as to include the supra-oesopha- 
geal ganglia, we may conclude that in the world of living 
creatures, where there is intelligence, there is brain, and 
that without this there can not be the slightest ray of 
reason. If life is a property of albuminoid substances in a 
given condition of equilibrium, intelligence is a property of 
a nervous system of a certain degree of evolution. 

Wherever such a principle is true the counterproof, 
or in the language of the scholar, the reciprocal, also must 
be true. If a brain or a ganglion functionating in the 
way we have described, be necessary and suflicient 
for the production of consciousness, each process being 
developed in that organ and with these properties, must be 
of necessity a conscious act. Is this true? The doubt is 
not sophistical, therefore a response is not superfluous. 

Who cannot enumerate any number of co-ordinated 
and complex actions, which from force of habit, we per- 
form automatically? These unconscious actions, for the most 
part as quick and precise as reflex* movements, were at 
first acts of intelligence; walking, swimming, bowing, dress- 
ing and undressing, the execution of many manual acts, cost 
us in our infancy, not a little mental labor, but are now 
performed unconsciously. Thus, that is, as degenerations 
of conscious facts, the zoologists explain many curious and 
complicated instincts, which can be transmitted by heredity. 



jdbyGoOglC 



The Limits of Psychology. 357 

It is therefore true! Instincts and habits t)ecome organ- 
ized not only from below, by a perfecting of reflex move- 
ments, but also from above, by a decadence of volitional 
and conscious actions. Now what does this mean? The 
mechanism of the transformation is of the simplest; these 
useful and automatic processes either no longer take place 
in the cerebrum, or still developing there, they involve fewer 
morphological elements, or the neurons are so reduced as to 
be insufficient for the production of consciousness. The orbit 
of organic life is thus restricted, the succession of functional 
acts more simple; a direct alliance is effected between 
subordinate neurons, the motor neuron is associated in phys- 
iological solidarity with the sensory neuron; the demand 
for spinal, bulbar or even cerebral curtailment is satisfied, 
but without touching that superior diffusion which invades 
vast cerebral zones and is the physical condition of con- 
sciousness. In fact, if the reaction does not change its 
seat, if it is not degraded anatomically, only repetition can 
render it unconscious, can degrade it physiologically. Thus 
it happens in visual images, that, bound up in a complicat- 
ed system of neurons, and increased to avalanches without 
any possibility of becoming less, they never issue from the 
consciousness, because they are continuously repeated. 

By many laborious paths, strewn with technical and 
scientific data, we have at length attained a sufficient height 
to take in a wide horizon. On this hotizon are stretched 
the great outlines. of an anatomy of the intelligence, that is, 
of the most magnificient objective point which biological studies 
can attain. We have fixed firmly and in exact terms the 
relations which exist between these three things, the world 
of subjective phenomena, the system of dynamic processes 
which are the conditions necessary for these, and the net- 
work of anatomical connections on which they are both 
based. The facts collected, on which we have touched in 
all their phases, have guided us to a scientific synthesis 
which has been brought forward and suggested by simple 
good sense. It seems wonderful that it has been possible 
to sustain a contrary view with so much vigor. 



jdbyGoOglc 



358 Eugenio Tanii. 

That for every function an organ is necessary, and that 
to the complexity of the function mu;t correspond the com- 
plexity of the organ, no one can doubt. Then why raise 
this singular exception which favors the intelligence at the 
expense of the brain? This causes us to consider how there 
weigh on the human mind those prejudices derived from 
ego-centrism and how, under innumerable disguises, and even 
under the mantle of science, they insinuate themselves deeply 
into its stratifications in spite of continuous effort to elim- 
inate them. 



jdbyGoOglc 



HYGIENE OF DEGENERACY.* 



As Illustrated by Charles and Mary Lamb. 



BY JAS. G. KIERNAN, M.L)., Cliicago. 



rjHILISTINISM inspired by its latent fetichism anent genius 
■ turgidly expands Dryden's paraphrase of t!ie dictum of 
Aristotle: 

Grut wll to mudiKS nearly Is alllM. 

And thin pirlltlons io Ih«lr tounds divide. 

And either thanks its stars that through escaping 
gfnius it escapes its eccentricities or, through the hope of 
passing platitudes for genius, exaggerates these. A little 
over a decade ago ! pointed out!" that careful analysis of 
the facts demonstrated that genius is not a prodiict of 
iiiorhid mind. In the exceptional instances where the two 
co-exist, genius is evidence of a healthy, conservative ele- 
ment struggling with the incubus of disease. One-sided gen- 
iuses are atavistic returns toward soundness. The nearer 
the genius to soundness, the more it is productive and the 
less the want of balance, A striking illustration of this ap- 
peared seven decades ago in an essay on "The Sanity of 
True Genius," emphatically maintaining the following po- 
sition: ' 



jdbyGoOglC 



360 Jas. G. Kieman. 

So far from the position hojding true, that great wit, 
(or genius in our modern way of speaking) has a necessary 
alliance with insanity, the greatest wit, on the contrary, 
will ever be found to be the sanest writers, it is impos- 
sible for the mind to conceive of a mad Shakespeare. The 
greatness of wit, by which the poetic talent is here chiefly 
to be understood, manifests itself in the admirable balance 
of all the faculties. JVladness is the disproportionate strain- 
ing or excess of any one of them. "So strong a wit", says 
Cowley, speaking of a poetical friend, 

dldNiniretohlmframl. 
As ill (hInEi but his ludeinenl ovtrunc 
His ludenKnl ]lk« lh< heavenly noon dfd itiow. 
Temperliie ih»t mlBhty s» Ixlow." 

The ground of the mistake is, that men, finding in the 
raptures of the higher poetry a condition of exhaltation, to 
which they have no parallel in their own experience, be- 
sides the spurious resemblance of it in dreams and fevers, 
impute a state of dreaminess and fever to the poet. But the 
true poet dreams, being awake. He is not possessed by his 
subject, but has dominion over it. In the groves of Eden 
he walks familiar as in his native paths. He ascends the 
empyrean heaven and is not intoxicated. He treads the 
burning marl without dismay; he wings his flight without 
self-loss through realms of chaos, "and old night." Or, if 
abandoning himself to that severer chaos of a "human 
mind unturned," he is content awhile to be mad with Lear, 
or to hate mankind (a sort of madness) with Timon; neither 
is that madness, nor this misanthropy, so unchecked, 
but that, never letting the reins of reason wholly go, while 
most he seems so to do, he has his better genius still 
whispering at his ear, with the good servant Kent suggest- 
ing saner counsels or with honest steward Flavius recom- 
mending kindlier resolutions. Where he seems most to re- 
cede from humanity, he will be found the truest to it. 
From beyond the scope of Nature if he summon possible 
existences, he subjugates them to the law of her consist- 
ency. He is beautifully loyal to that sovereign directress 
even when he appears most to betray and desert her. His 
ideal tribes submit to policy; his very monsters are tamed 
to his hand even as that wild sea-brood shepherded by 
Proteus. He tames, and he clothes them with attributes of 
flesh and blood till they wonder at themselves, like Indian 
Islanders forced to submit to European vesture. Caliban 
and the witches, are as true to the laws of their own na- 
ture (ours with a difference) as Othello, Hamlet, and Mac- 
beth. Herein the great and the little wits are differenced. 



jdbyGoOglC 



Hygiene of Degeneracy. 361 

If the latter wander ever so little from nature or actual ex- 
istence, they lose themselves and their readers. Their 
phantoms are lawless; their visions nightmareB. They do 
not create,; which implies shaping and consistence. Their 
imaginations are not active for to be active is to call some- 
thing into act and form, but passive as men in sick dreams. 
For the supernatural or something super-added to what we 
know of nature, they give you the plainly non-natural. 
And if this were all and these mental hallucinations were 
discoverable only in the treatment of subjects out of nature, 
or transcending it, the judgment might with some plea be 
pardoned if it ran riot, and a little wantonized; but even the 
describing of real and everyday life, that which is before 
their eyes, one of these lesser wits shall more deviate from 
nature — show more of that inconsequence which has a nat* 
ural alliance with frenzy than a great genius in his "mad- 
dest fits" as Withers sometimes calls them. We appeal to 
any one that is acquainted with the common run of Lane's 
novels as they existed just ere and just after the Eigh- 
teenth century, those scanty intellectual viands of the 
whole female reading public, till a happier genius arose, 
and expelled forever the innutritions phantoms, whether he 
has not found his brain more "betossed," his memory more 
puzzled, his sense of when and where more confounded, 
among the improbable events, the incoherent incidents, the 
inconsistent characters or no-characters of some third-rate 
loving intrigue, where the persons shall be a Lord Glenda* 
mour and a Miss Rivers, and the scene only alternates be- 
tween Bath and Bond street, whether a more bewildering 
dreaminess were not induced upon him, than he has felt 
when wandering over all the fairy grounds of Spencer. In 
the production we refer to, nothing but name and place is 
familiar; the persons are neither of this world nor of any 
other conceivable one; an endless string of activities with- 
out purpose, of purpose destitute of motive; we meet phan- 
toms in our own walks; fantasques only christened. In the 
poet we have names which announce fiction; and we have 
absolutely no place at all, for the things and persons of 
the Fairy Queen prate not of their "whereabout." But in 
their inner nature and the taw of their speech and actions 
we are at home and upon acquainted ground. The one ■ 
turns lif«l into, a dream; the other to the wildest dreams 
gives the sobrieties of every day occurrences. By what 
subtile art of tracing the mental process it is effected we 
are not philosophers enough to explain, but in that won- 
derful episode of the cave of Mammon, in which the money 
God appears first in the lowest form of a miser, is then a 



jdbyGoOglC 



362 Jas. G. Kieman. 

worker of metals and becomes the god of all the treasures 
of the world and has a da,i]ghter. Ambition, before whom 
all the world kneels for favors, with the Hesperian fruit, 
the waters of Tantalus, with Pilate washing his hands 
vainly but not impertinently, in the same stream, that we 
should be at one moment in the eye of any hoarder of treas- 
ures only at the next by the forge of the Cyclops, in a pal- 
ace and yet in hell, all at once with the shifting mutations 
of the most rambling dream, our judgment all the time 
awake and neither able or willing to detect the fallacy, is a 
proof of that hidden sanity which still guides the poet in 
his wildest seeming aberrations. 

It is not enough to say that the whole episode is a copy 
of the mind's conceptions in sleep. It is in some sort, but 
what a copy. Let the most romantic of us that has been 
entertained all night with the spectacle of some wild and 
magnificent vision, recombine it in the morning, and try it 
by waking judgment. That which appeared so shifting and 
yet so coherent, while that faculty was passive, when it 
comes under cool examination shall appear so reasonless 
and so unlinked, that we are ashamed to have been so de- 
luded; and to have taken though but in sleep a monster for 
a god, ■ But the transitions in this episode are every whit 
as violent as in the most extravagant dream and yet the 
waking judgment ratifies them." 

This calm temperate recognition of sanity as character- 
ized by well balanced control of impulsive tendencies in 
thought and action is worthy the ablest alienist, yet' it is not 
rarely found in those insane whose disorder has swept over 
a sound mental back-ground. He who has seen this sound 
mental background struggle with the storm and stress of 
sunstroke and traumatism is naturally of the opinion of Col- 
eridge that often, 

"When a man mistakes his thoughts for persons and 
things he is mad. Madness is not simply a bodily disease. 
It is the sleep of the spirit with certain conditions or wakeful- 
ness; that is to say, lucid intervals. During this sleep or 
/ecession of the spirit the lower or bestial states of life rise up 
into action and prominence. It is an awful thing to be eter- 
nally tempted by the perverted senses. The reason may re- 
sist for a long time, it does resist for a long time; but too 
often, at length, it yields for a moment and the man is 
mad forever. An act of the will is, in many instances, 



jdbyGoOglC 



Hygiene of Degeneracy. 363 

precedent to complete insanity. Bishop Butler said that he 
was all his life struggling against the devilish suggestions 
of his senses which would have maddened him if he had 
relaxed the stern wakefulness of his reason for a moment." 

Mystic as this seems it is but a paraphrase of 
modern clinical psychiatry with the secondary or later 
acquired ego substituted for the spirit. The forebrain, as 
Meynert* has shown, is an inhibitory apparatus against the 
lower and more instinctive natural impulses. The higher its 
development the greater is the tendency to subordinate the 
particular to the general. Even in the lower animals a high 
state of social growth occurs as in the communities of bees 
and ants. The same is the case in the development of 
man in the infant, a being entirely wrapped in its instincts 
of self-preservation, the "primary ego" is predominant and 
the child is an egoistic parasite. As development goes on, 
this standpoint is passed, conscience assumes its priority, 
the fore-brain acts as a check on the purely vegetative 
functions, and the "secondary ego" takes precedence over 
the primary one. This is the general order of society des- 
ignated as civilization or social order. If this inhibition 
becomes weakened, disordered predominance of the natural 
instinct or impulses occurs, and when it is totally lost the 
individual is in the position of a criminal who opposes the 
ethical order of society; a parasite and one of the worst 
kind, one who not only lives upon his host but destroys 
him in so doing. 

Kate Sanbornt is of the opinion that the asserter of 
the sanity of true genius, Charles Lamb can not be consid- 
ered a convincing authority on this side of the discussion 
because of his attacks of lunacy and Carlyle's bitter phrase 
anent Lamb's "diluted insanity." However, Charles Lamb 
demonstrates the error of diagnosing abnormalities from an 
author's writings. No alienist could discover in Lamb's 
writings degenerative taint. Indeed their conservative hu- 
mor shows mental balance to an unusual degree. They 



jdbyGoOglc 



364 Jas. G. Kieman. 

display a "Sanity of True Genius" that strikingly evinc- 
es the mental equipose thus outlined by Herzen:* 

The conscious mental process betrays an imperfection 
of the cerebral organization, for it indicates the presence of 
a new unusual activity which deranges the equilibrium, the 
innate or previously acquired automatism and which does 
not find a well-formed mechanism ready to discharge it. 
The conscious mental process is the transitory phase of an 
inferior to a superior cerebral organization. It expresses 
novelty, incertitude, hesitation, groping, astonishment, im- 
perfect association and incomplete organization, a want of 
promptitude and exactness in transmission, a loss of tenure 
in the phenomena of reaction. It indicates that the nerv- 
ous paths are not sufficiently cleared or distinctly enough 
traced to permit without destruction in the final effect, 
reflex movements or reflex ideational sensations. 

The degree of conscious mental processes will hence deter- 
mine the amount of attention. Attention, as Darwin points 
out, is more important than any other human faculty for 
intellectual progress. The amount of attention will hencu 
be comparatively little in the ape, lunatic and phitistine 
since, as Herzen points out, the power of new ideas to 
create states of uncertainty will depend on the absence or 
presence of preformed paths, or in other words, on the 
power of association. This power being greatest in the 
genius, the power of attention is greatest in him. Hagen 
taking issue with this position insists that genius differs 
from the normal type in being dominated by one idea which 
it cannot abandon. Ribott hitting at Hagen's error finds 
that: 

In every sane person there is almost always one 
dominant thought which controls his conduct, the 
thought of pleasure, money, ambition, his soul's salva- 
tion and the like. This fixed idea which persists 
through life save where it is superseded by some other 
finally becomes a fixed passion, which proves that attention 
and all its modes depend upon affective states. The trans- 
formation of attention into a fixed idea is still more clearly 
seen in great men. "What is a great life.'" asks Alfred 
de la Vigne. "A thought of youth realized in mature 
years," If men en masse be observed, not persons of trained 



jdbyGoOglC 



Hygiene of Degeneracy. 365 

and cultivated minds, as psychologists almost always do, it 
will readily be seen that spontaneous and above all volun- 
tary attention are exceptional states. Eliminate first the 
routine of life, that vast mass of habits which make us act 
like automatons with vague and intermittent states of con- 
sciousness, eliminate those periods of our mental life in 
which we are passive because the order and succession of 
our state of consciousness come to us from without and the 
series of states is imposed upon us in reading a book of 
average interest or work manually or otherwise presuppos- 
ing a succession of acts in a set order. Eliminate the state 
of relative repose wherein one is thinking of nothing at all 
that is wherein the states of consciousness have neither 
intensity nor clear definition as reverie in all its degrees, 
eliminate states of passion and strong agitations with their 
irregular fluctuations and their diffusion or movement. These 
and perhaps a few other states eliminated, what remains 
may be credited to the general account of attention; and 
in this general account the cases of spontaneous attention 
constitute the great majority of the entries while the clear 
and indisputable cases of voluntary attention are few; with 
many men they hardly amount to anything. 

As I pointed out in the Academy* six years ago, to the 
limitedly educated mind of the average philistine, insane 
delusions seem akin to poetic fancy because he has never 
passed from the tyranny of custom, and to his misoneism, 
novelty is productive only of incertitude. Indeed the 
delusions of the insane are so much more nearly allied to his 
own mental limitations that he is very apt to look upon them 
as evidences of sanity white he denounces the fancies of 
the wit, poet or artist, the discoveries of the scientist or the 
creed of the ethical teacher, which cause him more mental 
perturbation, as emanations from cranks. In politics this 
type of philistine has more than once denounced the "golden 
rule" as the "iridescent dream of a lunatic." Such Philistin- 
ism pleases the misoneism of the mediocre whence the 
enthusiasm over platitudes and the reign of the philistine 
in newspaper art, literature and science and whence the 
frequent repetition of Horace's epigram. 

The degenerate lays stress on the outre relations of 
familiar things and, like the savages, is great in analogies. 

■Alienist and Neurologist. Jiinu«rr, 1S92. 



jdbyGoOglC 



366 Jas. G. Kiertiati. 

The normal being from his power of inter-association, links 
familiar things into an entity whose origin without the Unks 
seems more insane than the outre creations of the degen- 
erate which affihate with the felichism latent in the Phil- 
istine despite centuries of culture. The pithy, homely 
humor of Charles Lamb seemed for this reason to the sour 
dogmatic philistine Carlyle "diluted insanity." 

Charles Lamb so learned through his acute insanity, 
the power of the insane to prevent and control insanity in 
themselves, that his keen recognition of the checks which 
constitute the difference between the normal and the insane 
would never lead an alienist to suspect the bad heredity of 
his family. 

Tlie paternal branch of the Lamb family came from the 
fens of Lincolnshire where, as has been shown by Murrell, 
laudanum-using is rife albeit with comparative immunity 
from the usual effect of opiophagism. In these districts 
degeneracy of type is frequent but ascribed to malaria. 
John Lamb, the father of Charles, was born of parents "in 
no very affluent circumstances," in a lonely fen county, 
seven miles from the nearest church, an occasional visit to 
which was a feat, so dangerous was then walking in the 
fens. While still a child John Lamb's family removed to 
Lincoln so poverty-stricken because of the insanity of its 
head, that John had to be made a foot-boy. The fact that 
lie subsequently became barrister's clerk indicates gentler 
early nurture than this early thrusting into the fierce strug- 
gle for existence would otherwise imply. John Lamb grew 
up humorous, gay, inflexibly honest and upriglit with a dash 
of chivalry in his nature and a poetic tendency whicii lim- 
ited by environment found voice in verse whose thought 
exceeded power of expression. At the age of fifty he 
became insane and died demented. His sister was an 
uncanny old soul whose silent ways and odder witchlike 
mutterings and mumblings coupled witli a wild look in her 
eyes as she peered out from under her spectacles made her 
an object of dread. The maternal ancestry of Lamb has 
received but little attention yet as Nisbet* points out, in it 



jdbyGoOglC 



Hygiene of Degeneracy, 367 

occurs neuropathic heredity. The mother exhibited that 
capricious affection often present in the degenerate. The 
maternal grandmother had that moral anesthesia and bru- 
tality toward mental suffering which is an offspring of 
degenerate egotism. Elizabeth Field, many years younger 
than John Lamb, her husband, was a handsome, dignified, 
pleasure seeking hysteric, lacking insight into child charac- 
ter. Toward Mary and Charles she never manifested 
maternal tenderness, iWary, a shy, sensitive, nervous, 
affectionate child, who early evinced liability to brain dis- 
order, peculiarly needed tender judicious care. 

The mother always loved John most* who was not 
worth one-tenth of Mary. John, the eldest, a handsome 
lively boy, became what good looks and favoritism were 
sure to make of an egotist. Dear, little, selfish, craving 
John of childhood, became big selfish John in manhood 
treated with indulgence by brother and sister who exempted 
him from any share of the family burden even when he was 
prosperous. Mary Anne Lamb, born December 3, 1764, 
was the third, while Charles was the youngest, of seven 
children. All died in infancy save John, Mary and Charles. 
Mary Lamb was brought up in a lower middle class home 
relieved alike from the stress of poverty and speculative 
wealth. She received her education in a day school, teach- 
ing, to use the yankee colloqualism, the three R's, The 
best of her education was the library of Mr. Salt, her fath- 
er's employer. Here she was early left to browse without 
prohibition on the principle advocated by Ruskin: 

Turntthe girl loose into the old library every day and let her 
alone- She will find what i,s good for her, you cannot; for. 
there is just this difference between the making of a girl's 
character and a boy's: you may chisel a boy into shape as 
you would a rock, or hammer him into it if he be of a bet- 
ter kind, as you would a piece of bronze, but you cannot 
hammer a girl into anything. She grows as a flower does; 
she will wither without sun; she will decay in hef sheath 
as a narcissus will, if you do not give her air enough; she 
may fall and defile her head in dust if you leave her with- 



jdbyGoOglc 



368 Jas. G. Kieman. 

out help at some moments of her life, but you cannot fetter 
her; she must take her own fair form and way if she takes 
any and in mind as in body must have always 

"Her household notions light and free, 

And steps of virgin liberty." 
Let her loose in the library as you do a fawn in the field. 
It knows the bad weed twenty times better than you, and 
the good ones too, and will eat some bitter and prickly ones 
good for it which you had not the slightest thought would 
liave been so. 

Anne Gilchrist taking issue with Ruskin (as to the 
policy of turning girls loose into a library) is of opinion that 
"A little selection however would have made the pasturage 
all the wholsomer to a child of Mary's sensitive brooding 
nature, for the witch stories and cruel tales of the suffer- 
ings of the martyrs on which she pored all alone, as her 
brother did after her, wrought upon her tender brain and 
lent their baleful aid to nourish those seeds of madness 
which she inherited." 

Autobiographical incidents of Mary Lamb's Margaret 
Green, the Young Mahometan, lend vraisemblance to this 
opinion. The maternal grandmother was housekeeper to a 
country family with a stately country mansion, to which 
Mary paid repeated visits. Her first visit was always to: 
A very large hall, which from being paved with marble was 
called the Marble Hall. The heads of the twelve Cjesars 
were hung around the hall. Every day 1 mounted on the 
chairs to look at them and to read the inscription under- 
neath, till I became perfectly familiar with their names and 
features. Hogarth's prints were below the Cjesars. I was 
very fond of looking at them and endeavoring to make out 
their meaning. An old broken battledore and some shuttle- 
cocks with most of the feathers missing were on a marble 
stab in one corner of the hall which constantly reminded 
me that there had once been younger inhabitants here than 
the old lady and her gray-headed servants. In another 
corner stood a marble figure of a satyr; every day 1 laid 
my hand on his shoulder to feel how cold he was. This 
hall opened into a room full of family portraits. They were 
all in dresses of former times; some were old men and 
women and some were children. I used to long to have a 
fiiiry's power to call the children down from heir frames to 
play with me. One little girl, in particular who hung by 
the side of the glass door which opened into the garden, 



jdbyGoOglC 



Hygiene of Degeneracy. 369 

I often invited her to walk there with me ; but she still kept her 
station, one arm around a little lamb's neck and in her 
hand a large bunch of roses. From this room I usu- 
ally proceeded to the garden. When I was weary of the 
garden 1 wandered over the rest of the house. The best 
suite of rooms I ever saw by any other light than what 
gleaned through the tops of the window-shutters which 
however served to show the carved chimney pieces and the 
curious old ornaments about the rooms; but the worked 
furniture and carpets of which 1 had heard such constant 
praises 1 could have but an imperfect sight of, peeping 
under the covers which were kept over them by the dim 
light; for I constantly lifted up a corner of the envious 
cloth that hid these highly praised rarities from my view. 

The bed-rooms were also regularly explored by me, as 
well to admire the antique furniture as for the sake of con- 
templating the tapestry hangings which were full of Bible 
history. The subject of the one which chiefly attracted my 
attention was Hagar and her son Ishmael. Every day I 
admired the beauty of the youth and pitied the forlorn state 
of him and his mother in the wilderness. At the end of 
the gallery into which these tapestry rooms opened was one 
door which having often in vain attempted to open it 1 con- 
cluded to be locked and finding myself shut out I was very 
desirous of seeing what it contained and though still foiled 
in the attempt I every day endeavored to turn the lock 
which, whether by.fipnstantly trying, I loosened, being prob- 
ably a very old am or that the door was not locked but 
fastened tight by time, I know. not. To my great joy, as 1 
was one day trying the lock as usual, it gave way and I 
found myself in this long desired room. It proved to be a 
very large library. This was indeed a precious discovery. 
I looked around on the books with the greatest delight: I 
thought I would read them every one. I now forsook all 
my favorite haunts and passed all my time here. I took 
down first one book then another. If you never spent whole 
mornings alone in a large library, you cannot conceive the 
pleasure of taking down books in the constant hope of find- 
ing an entertaining book among them; yet after many days 
meeting with nothing but disappointment, it became less 
pleasant. All the books within my reach were folios of the 
gravest cast. I could understand very little that I read in 
them and the old dark print and the length of the lines 
.made my eyes ache. 

When I had almost resolved to give up the search as 
friiitiess I perceived a volume lying in an obscure corner of 



jdbyGoOglC 



370 Jas. G. KUman. 

the room. I opened it; it was a charming print; the let- 
ters were almost as large as the type of the family Bible. 
In the first page I looked into I saw the name of my favor- 
ite Ishmael whose face I knew so well from the tapestry 
and whose history 1 had often read in the Bible. I sat 
myself down to read this book with the greatest interest. 
The title of it was "Mahometanism Explained." A great 
many of the leaves were torn out, but enough remained to 
make me imagine that Ishmael was the true son of Abra- 
ham. I read here that the true descendants of Abraham 
were known by a light which streamed from the middle of 
their foreheads. It is said that Ishmael's father and mother 
first saw this light streaming from his forehead as he was 
lying asleep in the cradle, I was very sorry so many of the 
leaves were torn out, for it was as entertaining as a fairytale. 
I used to read this history of Ishmael and then go back and 
look at him in the tapestry and then read his history again. 
When I had almost learned the history of Ishmael by heart 
I read the rest of the book and then I came to the history 
of Mahomet, who was there said to be the last descendant 
of Abraham. 

If Ishmael had engaged so much of my thoughts how 
much more so must Mahomet. His history was full of noth- 
ing but wonders from beginning to end. The book said 
that those who believed all the wonderful stories which 
were related of Mahomet were called Mahometans and True 
Believers; I concluded that I must be a Mahometan for I 
believed every word 1 read. 

At length I met with something which I also believed 
though I trembled as I read it. This was that after we are 
dead we are to pass over a narrow bridge which crossed a 
bottomless gulf. The bridge was described to be no wider 
than a silken thread and it is said that all who were not 
Mahometans would slip on one side of this bridge and drop 
into the tremendous gulf that had no bottom. I considered 
myself as a Mahometan yet I was perfectly giddy whenever 
I thought of passing over this bridge. One day seeing the 
old lady totter across the room, a sudden terror seized me 
for I thought how would she ever be able to get- ovei the 
bridge. Then too it was that I first recollected that my 
mother would also be in imminent danger for I imagined 
she had never heard the name of Mahomet because I fool- 
ishly conjectured this book had been locked up for ages in 
the library and was utterly unknown to the rest of the 
world. 

All my desire was now to tell them the discovery I had 



jdbyGoOglC 



Hygiene of Degeneracy. 371 

made for 1 thought when they knew of the existence of 
"Mahometanism Explained" they would read it and become 
Mahometans to insure themselves a safe passage over the 
silken bridge. But it wanted more courage than I possessed 
to break the matter to my intended converts, 1 must 
acknowledge that I had been reading without leave and the 
habit of never spea}(ing or being spoken to, considerably 
increased the difficulty. My. anxiety on this subject threw 
me into a fever. I was so ill that my mother thought it 
necessary to sleep in the same room with me. In the middk- 
of the night I could not resist the strong impulse to tell her 
what preyed so much on my mind. 1 awoke her out of a 
sound sleep, and begged she would be so kind as to be a 
Mohometan. She was very much alarmed for she thought 
1 was delirious which I believe I was since I tried to explain 
the reason of my request but it was in such an incoherent 
manner that she could not at all comprehend what 1 was 
talking about. The next day a physician was sent for, and 
he discovered by several questions that he put to me, that 
I had read myself into a fever. He gave me medicine and 
ordered me to keep very quiet and said he hoped in a few 
days I should be very well. But, as it was a new case to 
him, he never having attended a little Mahometan before, if 
any lowness continued after he had removed tlie fever, he 
would, with my mother's permission, take me home with 
him to study this extraordinary case at his leisure. He could 
then hold a consultation with his wife, who was very use- 
ful to him in prescribing remedies for the maladies of his 
younger patients. 

Reading here merely tinged a psychosis frequent in 
degenerate children who are permitted to be unduly intro- 
spective. Children of such heredity early manifest, as 
Krafft-Ebing* has shown, decided neurotic excitability and 
tend to neuroses at physiologic crises like the first and sec- 
ond dentition and the onset and close of puberty. Slight 
physical or mental perturbation is followed by insomnolence, 
delirium, hallucinations etc. Hypera^sthesia of the nervous 
system and excessive reaction to pleasant . or offensive 
impressions exist. Vasomotor instability is present, pallor, 
blushing, palpitations or precordial anxiety result from trivial 
moral or physical excitants. There is precocity or aberration 
of the sexual instinct. The disposition is irritable. The 

*L>hrbuch d«r Piychlatrle. 



jdbyGooglc 



372 Jas. G. Kieman. 

grasshopper is a burden. Psychic pain arises from the most 
trivial cause and finds expression in emotional outbursts. 
Sympathies and antipathies are equally intense. The men- 
tal life swings between periods of exaltation and depression 
alternating with brief epochs of healthy indifference. Ego- 
tism is supreme and morality absent or perverted. This 
absence or perversion is often concealed under the guise of 
moral superiority, religiosity or cant. Vanity and jealous 
suspiciousness are common. The intellect and temper are 
exceedingly irregular. Monotonously feeble, scanty ideation 
passes readily into seeming brilliance even to the extent of 
hallucinations. These last ideas are barren as a rule 
because generated so rapidly as to destroy each other ere 
they pass into action. Energy fails ere aught can be' com- 
pleted. The inability to distinguish between desires and 
facts produces seeming mendacity. The will in its apparent 
exuberance, its capricious energy and innate futility 
matches and distorts the one sided talent or whimsical genius 
which may exist. The whole of this mental state may not 
be present. The tendency to introspection, to morbid fear, ' 
to gloom, to hallucinations, to alternations of depression and 
exaltation may occur in a degenerate child in whom has 
been otherwise preserved that secondary ego which is the 
latest and greatest acquirement of the race. Indeed much 
morbid energy, otherwise distorting this, may pass off 
through the mental channels just outlined, fhis seems to 
have been recognized by the physician into whose care Mary 
fell. In this confusional insane state, for it was much more 
than a delirium, he took her to his home where, by dis- 
couragement of introspection through rational sympathy, and 
diildlike wholesome pleasure, she recovered. With the 
cruelty of ignorance Mary's mother and grandmother had 
suffered her to battle in silence and solitude with the phan- 
toms of a too sensitive brain. "Polly what are those poor, 
crazy, moythered brains of yours thinking always" was Mrs. 
Field's encouraging way toward her thoughtful suffering grand- 
child. The words in the tale "my mother almost wholly dis- 
continued talking to me. I scarcely ever heard a word 
addressed to me from morning to night," have the ring of bitter 



jdbyGoOglC 



Hygiene of Degeneracy. 373 

personal experience. Mary did not imbibe any bitter feeling 
because of this stupid brutal insouciance. She repaid it by that 
self-sacrificing devotion which caused her great calamity. 
The degenerate absence of that finer tenderness and sym- 
pathy which constitutes human nature in its most alluring 
aspect eminently unfitted Mary's mother and grandmother 
for the training of a neurotic child. The primary ego usu- 
ally so prominent in degenerates, while decidedly obtrusive 
in John, Mrs. Lamb and Mrs. Field, was wonderfully subor- 
dinate in Mary and Charles Lamb for children of such 
heredity. Charles was a weakly child. He had frequent 
night terrors, learned to speak with difficulty and stammered 
throughout life. Through the pleasure seeking nature of his 
mother, whose maternal tenderness like that of most hys- 
terics had been exhausted on her first born, his care 
devolved on Mary who nursed and mothered him. This 
outlet for her affection naturally dispelled her loneliness. 
In after life she warmly described the wholesome curative 
influence upon her troubled mind, which devotion to baby 
Charles brought. As he grew older Charles repaid the 
debt with a love sublimely adequate to the strain of a ter- 
rible emergency. As his mind unfolded, he found in her 
affectionate intelligence, the same genial care that had 
cherished his feeble frame into health. With his little hand 
in hers, he first trod the Temple Gardens, spelled out the 
inscriptions on the sun-dial and on the tomb-stones in the 
old burying ground, and wondered, finding only the virtuous, 
"where all naughty people were buried." 

The familiar features of the neurotic child appear in 
that auto- biographical sketch Charles Lamb contributed to 
Mrs. Mary Leicester's School entitled "Maria Hofre or the 
Witch Aunt." 

I was brought up in the country. From my infancy I 
was always a weak and tender -spirited girl, subject to 
fears and depressions. My parents, and particularly my 
mother, were of a very different disposition. They were 
what is usually called gay. They loved pleasure and 
parties and visiting; but as they found the turn of my 
mind to be quite opposite, they gave themselves little trouble 
about me, but upon such occasions generally left me to my 



jdbyGoOglfr 



374 Jas. G. Kieman. 

choice, which was much oftener to stay at home and in- 
dulge myself in my solitude than to join in their rambling 
visits. 1 was always fond of being alone, yet always in a 
manner afraid. There was a book closet which led into my 
mother's room. Here 1 was eternally fond of being shut up 
by myself, to take down whatever volume I pleased, and 
pore upon them no matter whether they were fit for my 
years or no, or whether I understood them. Here when the 
weather would not permit my going into the dark walk (my 
walk as it was called) in the garden, here when my parents 
have been from home I have stayed for hours together till 
the loneliness which pleased me so at first has at length be- 
come quite frightful and I have rushed out of the closet into 
the inhabited parts of the house and sought refuge in the 
lap of some one of the male servants or of my aunt who 
would say, seeing me look pale, that Maria had been 
frightening herself with some of those nasty books, so she 
used to call my favorite volumes which 1 would not have 
parted with, no, not with one of the least of them if I had 
had the choice to be made a fine princess and to govern 
the world. But my aunt was no reader. She used to ex- 
cuse herself and say that reading hurt her eyes. I have 
been naughty enough to think that this was only an ex- 
cuse for I found that my aunt's weak eyes did not prevent 
her frym poring ten hours a day upon her Prayer B<M)k or 
her favorite, Thomas- a- Kempis. But this was always her 
excuse for not reading any of the books 1 recommended. 
My aunt was my father's sister. She had never been mar- 
ried. My father was a good deal older than my mother 
and my aunt was ten years older than my father. As 1 
was often left at home with her and as my serious dispo- 
sition so well agreed with her's, an intimacy grew up be- 
tween the old lady and me, and she would often say that 
she loved only one person in the world and that was me. 
Not that she and my parents were on very bad terms but 
the old lady did not feel herself respected enough. The 
attention Jnd fondness which she showed to me, conscious 
as I was that 1 was almost the only being she felt any- 
thing like fondness to, made me love her as it was natural. 
Indeed I am ashamed to say that I fear I almost loved her 
better than both my parents put together. But there was 
an oddness, a silence about my aunt which was never inter- 
rupted but by her occasional expressions of love to me that 
made me stand in fear of her. An odd look from under her 
spectacles would sometimes scare me away when I have 
been peering up in her face to make her kiss me. Then 
she had a way of muttering to herself, which, though it 



jdbyGoOglC 



Hygiene of Degeneracy. 375 

was good words and religious words she was mumbling, 
somehow I did not like. My weak spirit and the fears I 
was subject to, always made me afraid of any personal 
singularity or oddness in any one. I am ashamed ladies to 
open so many particulars of our family, but indeed it is 
necessary to the understanding of what 1 am going to tell 
you, of a very great wickedness which I was guilty of to- 
ward my aunt. But I must return tu my studies and tell 
you what books I found in the closet and what reading 1 
chiefly admired. There was a great Book of Martyrs in 
which I used to read or, rather, I used to spell out meanings, 
for I was too ignorant to make out many words, but there 
it was written all about those good men who chose to be 
burnt alive rather than forsake their religion, and become 
naughty papists. Some words I could make out, some I 
could not, tmt I made out enough to fill my little head 
with vanity; and I used to think J was so courageous I 
could be burnt too and I would put my hands upon the 
flames which were pictured in the pretty pictures wliich the 
baok had and feel them. But you know, ladies, there is a 
great difference between the flames in a picture and a real 
fire; and 1 am now ashamed of the conceit which I had of 
my own courage and think how poor a martyr I should 
have made in those days. Then there was a book not so 
big but it had pictures in it and was called Culpeper's 
Herbal. It was full of pictures of plants and herbs, but 1 
did not care for that. Then there was Salmon's Modern 
History out of which I picked a good deal. It had pictures 
of Chinese gods and the great hooded serpent which ran 
strangely in my fancy. There were some law books too, 
but the old English frightened me from reading them. But 
above all, what I relished was Stackhouse's History of the 
Bible where tliere was the picture of the ark and all the 
beasts getting into it. This delighted me because it puz- 
zled me and many an aching head have I got poring into it 
and contriving how it might be built with such and such 
rooms to hold all the world if there should be another flood; 
and sometimes settling what pretty beasts should be saved 
and what should not; for 1 would have no ugly or deformed 
beasts in my pretty ark. But this was only a piece of 
folly and vanity that a little reflection might cure me of. 
Foolish girl that I was to suppose that any creature is 
really ugly that has all its limbs contrived with heavenly 
wisdom and was doubtless formed in some beautiful end 
though a child cannot comprehend it. Doubtless a frog or 
a toad is not uglier in itself than a squirrel or a pretty 
green lizard, but we want understanding to see it. 



jdbyGoOglC 



376 las. G. Kieman. 

These fancies, ladies, were not so very foolish or 
naughty perhaps but that they might be forgiven in a child 
six years old, but what I am going to teh 1 shall be 
ashamed of and repent I hope as long as I live. It will 
teach me not to form rash judgment. Besides the picture 
of the Ark and many others which I have forgotten Stack- 
house contained one picture which made more impression 
upon my childish understanding than all the rest. It was 
the picture of the raising up of Samuel which 1 used to 
call the Witch of Endor Picture. I was always very fond 
of picking up stories about witches. There was a book 
called "Glanvil on Witches," which used to lie about in 
this closet. It was thumbed about and showed it had been 
much read in former times. This was my treasure. Here 
I used to pick out the strangest stories. My not being abl* 
to read them very well probably made them appear more 
strange and out of the way to me. But 1 could collect 
enough to understand that witches were old women who 
gave themselves up to do mischief, how by the help of 
spirits as bad as themselves, they lamed cattle and made 
the corn not grow; and how they made images of wax to 
stand for people that had done them an injury or they 
thought had done them an injury and how they burnt the 
images before a slow fire and stuck pins in them; and the 
persons which these waxen images represented, howaverfar 
distant, felt all the pains and torment in good earnest, 
which were inflicted in show upon these images. Such a 
horror I had of these wicked witches that though I am row 
better instructed and look upon all these stories as mere 
idle tales and invented to fill people's heads with nonsense 
yet I cannot recall to mind the horrors which 1 then felt 
without shuddering and feeling something of the old fit 
return. 

This foolish book of witch stories had no pictures in it, 
but I made up for them out of my own fancy and out of 
the great picture of the rising Samuel in Stackhouse, I 
was not old enough to understand the difference there was 
between these silly improbable tales which imputed such 
powers to poor old women who are the most helpless 
things in the creation, and the narrative in the Bible which 
does not say that the witch or pretended witch raised up 
the dead body of Samuel by her own power, but as it 
clearly appears, he was permitted by the Divine will to 
appear to confound the presumption of Saul and that the 
witch herself was really as much frightened and confounded 
at the miracle as Saul himself, not expecting a real appear- 



ed byCoOglc 



Hygiene of Degeneracy. 377 

ance, but probably having prepared some juggling slight- 
of-hand tricks and sham appearance to deceive the eyes of 
Saul, whereas neither she nor any one living had ever the 
power to raise the dead to life but only He who made 
them from the first. These reasons 1 might have read in 
that very book since I was older, but at that time I looked 
at little beyond the picture. 

These stories of witches so terrified me that my sleep 
was often broken and in my dreams I always had a fancy 
of a witch being in the room with me. I know now that 
it was only nervousness, but though I can laugh at it now 
as well as you ladies, if you knew what I then suffered, 
you would be thankful that you have had sensible people 
about you to instruct you and teach you better. I was let 
grow up wild like an ill weed and thrived accordingly. One 
night that I had been terrified in my sleep with my imag- 
inations, I got out of bed and crept softly to an adjoining 
room. My room was next to where my aunt usually sat 
when she was alone. Into her room I crept for relief from 
my fears. The old lady was not yet retired to rest but was 
sitting with her eyes half open, half closed, her spectacles 
tottering upon her nose; her head nodding over her prayer 
book, her lips mumbling the words as she had read them 
or half read them in her dozing posture; her grotesque ap- 
pearance, her old-fashioned dress resembling what I had 
seen in that fatal picture in Stackhouse. All this with the 
dead time of night it seemed to me (for I had gone through 
my first sleep) what I beheld was not my aunt but some 
witch. Her mumbling of her prayers confirmed me in this 
shocking idea. I had read in Glanvil of those wicked 
creatures reading their prayers backwards and 1 thought 
that this was the operation which her lips were at this 
time employed about. Instead of flying to her friendly lap 
for that protection which I had so -often experienced when I 
have been weak and timid, 1 shrunk back terrified and 
bewildered to my bed, where I lay in broken sleeps and 
miserable fancies till the morning which I had so much rea- 
son to wish for, came. My fancies a little wore away with 
the light, but an impression was fixed which could not for 
a long time be done away. In the daytime when my 
father and mother were about the house when I was then 
familiarly speaking to my aunt, my fears all vanished; and 
when the good creature has taken me upon her knees and 
shown me any kindness more than ordinary at such times 
I have melted into tears and longed to tell her of what naughty 
foolish fancies I had had of her. But when nifiht returned 



jdbyGoOglC 



378 tas. G. Kieman. 

that figure which I had seen recurred, the posture, the half 
closed eyes, the mumbling and muttering which 1 had 
heard. A confusion was in my head, who it was I had 
seen that night, it was my aunt and it was not my aunt; 
it was that good creature who loved me above all the 
world, engaged at her good task of devotion, perhaps pray- 
ing for some good to me. Again it was a witch, a creature 
hateful to God and man, reading backward the good prayers, 
who would perhaps destroy me. In these conflicts of mind 
1 passed several weeks till by a revolution in my fate I 
was removed to the house of a female relation of my moth- 
er, in a distant part of the county who had come on a vis- 
it to our house, and observing my lonely ways and appre- 
hensive of the ill effect of my mode of living upon my 
health, begged leave to take me home to her house to 
reside for a short time. I went with some reluctance at 
leaving my closet, my dark walk and even my aunt who 
had been such a source of both love and terror to me. But 
I went and soon found the good effect of a change of scene. 
Instead of melancholy closets and lonely avenues of trees I 
saw lightsome rooms and cheerful faces. I had companions 
of my own age. No tjooks were allowed me but what 
were rational or sprightly that gave me mirth or gave me 
instruction. 1 soon learned to laugh at witch stories and 
when I returned after three or four months absence to my 
own house my good aunt appeared to me in the same light 
which I had viewed her from my infancy before the foolish 
fancy possessed me, or, rather, 1 should say, more kind, more 
fond, more loving, than ever before. It is impossible to say 
how much good that lady (the kind relation of my mother 
that I spoke of) did to me by changing the scene. Quite 
a new turn of ideas was given to me. 1 became sociable 
and companionable. My parents soon discovered a change 
in me; and I found a similar alteration in them. They 
have been plainly more fond of me since that change, as, 
from that time, I learned to conform myself more to their 
way of living. I have never since had that aversion to 
company and going out with them, which used to make 
them regard me with less fondness than they would have 
wished to show. I impute almost all that I had to com- 
plain of in their neglect, to my having been a little, unso- 
ciable, uncompanionable mortal. 1 lived in this manner for 
a year or two passing my time between our house and the 
lady's who so kindly took me in hand, till, by her advice, I 
was sent to this school where I had told you ladies what, 
for fear of ridicule, I never ventured to tell any person be- 
sides, the story of my foolish and naughty fancy. 



jdbyGoOglC 



Hygiene of Degetteracy. 379 

Ere the child acquires new elements of consciousness, 
these create incertitude and hence fear, and in non-degen- 
erates lead, as Sully* has shown, to pantomime of shutting 
out the disagreeable impression. 

The suspicional gloom present in otherwised healtliy 
degenerates, the fears of childhood described, revive an atavis- 
tic malign, occult explanation of nature. To this, victims 
have been offered during the 17th century in England and 
America, as late as the early 19th on the continent of 
Europe and are offered by people somewhat advanced in 
evolution to-day. Among the Pennsylvania Dutch the witch 
doctor is still a potentate. Charles Lamb, as a child, 
adopted in regard to witches the dogmas of judges who 
ridiculing the expert testimony of scientists like Reginald 
Scott, Zacchias and Wier decided emphatically that there 
must be witches because both the statute book and the 
Bible said so and who doubted this evidence must be an 
atheist. Glanvil, to whom Lamb refers, was one of those 
legal hammers of witches whose brutal pedantry, just 
described, defying the common law, reeks with human gore. 
The neurotic element in the Lambs at once drew Charles 
to these witch tales and aggravated their effect, otherwise 
as harmless. Ghost and witch tales do not injure healthy 
children. As Sully remarks: 

"It is a happy circumstance in healthy children that 
that most prolific excitant of fear, the presentation of some- 
thing new and uncanny is also provocative of curiosity with 
its impulse to look and examine. Even animals are some- 
times divided in the presence of something strange between 
fear and curiosity, and children's curiosity is much more 
lively than others. A very tiny child, on first making 
acquaintance with some form of physical pain, as a bump 
on the head, will deliberately repeat the experience by 
knocking his head against something as if experimenting 
and watching the effect. A clearer case of curiosity over- 
powering fear is that of a. child who, after pulling the tail 
of a cat in a bush and getting scratched proceeded to dive 
into the bush again. Still more interesting here are gradual 
transitions from actual fear, before the new and strange, 
to bold inspection. The child who was frightened by her 

•Psvcholoey of ChlUhaoJ. 



jdbyGoOglC 



380 Jas. G. Kiernan. 

Japanese doll insisted on seeing it every day. The behavior 
of one of these small persons on the arrival at the house of 
a strange dog, of a dark foreigner or some other startling 
novelty is a pretty and amusing sight. The first overpow- 
ering timidity, the shrinking back to the mother's breast, 
followed by curious peers, then by bolder outstretchings of 
head and arms, mark the stage by which curiosity and 
interest gain on fear and finally leave it far behind. Very 
soon we know the small timorous creatures will grow into 
bold adventurers. They will make playthings of the alarm- 
ing animals and of the alarming shadows too. Later on 
still perhaps they will love nothing so much as to probe 
the awful mysteries of gunpowder. 

One palliative of these early terrors is the instinct of 
sheltering, of refuge-taking. The first manifestations of 
what is called the social nature of children are little more 
than the reverse side of their timidity. A baby will cease 
crying at night on hearing the familiar voice of mother or 
nurse because a vague sense of human companionship does 
away with the misery of the black solitude, A frightened 
child probably knows an ecstasy of bliss when folded in the 
protective embrace of a mother's arms. Even the most 
timid children never have the full experience of terror, so 
long as there is within reach that secure base of all their 
reconnoitring excursions, the mother's skirts, Happy those 
little ones who have ever near them loving arms, within 
whose magic circle the oncoming of the cruel fit of terror is 
instantly checked giving place to a delicious calm, 

Charles and Mary Lamb had no such shelter. The 
affectionate witch aunt was worse than none. Charles 
reaped the special benefit of Mary's tenderness during his 
attack of variola just ere the onset of the period of the 
second dentition. Three years later Charles passed from 
her care to the Christ's Hospital School, then under Boyer 
one of those abnormal school masters who sensuously 
enjoyed whipping boys. In the Lamb household the domes- 
tic outlook grew dark as soon as Mary was grown up. Her 
father's faculties received a shock and her mother became 
a hysteric paralytic. At fifteen Charles left Christ's Hos- 
pital to take up the burdens of an adult. Mary had not 
only to make head against sickness, helplessness and old 
age but to support the family by millinery. She employed 
herself thus from the age of twenty-one to thirty-two. 



jdbyGoOglC 



Hygiene of Degeneracy. 381 

When Mary was thirty and Charles twenty, the father, fallen 
into dementia, had been pensioned off by his employers. 
Charles, under the stress of puberty, of an unfortunate love 
affair and of liis struggles to support the family neglected 
by the pet John, became so insane as to require hospital 
care. He wrote to Coleridge therefrom: 

My life has been somewnat diversified of late. The 
six weeks that finished last year and began this, your very 
humble servant spent very agreeably in a madhouse at 
Hoxton. 1 am somewhat rational now and don't bite any- 
one. But mad I was. And many a vagary my imagination 
played with me, enough to make a volume if all were told. 
My sonnets I have extended to the number of nine since I 
saw you, and will some day communicate to you, 1 am 
beginning a poem in blank verse. Coleridge, it may con- 
vince you of my regard for you when 1 tell you my head 
ran on you in my madness as much almost as on another 
person who I am inclined to think was the more immediate 
cause of my temporary frenzy. The sonnet 1 send you has 
small merit as poetry; but you will be curious to read it 
when I tell you it was written in my prison house in one 
of my lucid intervals. 

TO MY SISTER. 



He was able to resume his usual labors as clerk in the 
India House after six weeks treatment. The psychosis was 
that unstable type of melancholia so frequent in degener- 
ates, in which flashes of exaltation through the emotional 
gloom are remembered with keen rapture. Anent these 
Lamb felt like Horace's "Happy Madman." 



jdbyGoOglC 



382 jas. G. Kieman. 

Lamb looked back on his insanity at times "with a gloomy 
kind of envy, for while it lasted he had many, many hours 
of pure happiness. Dream not, Coleridge, he writes, of hav- 
ing tasted all the grandeur and wildness of fancy till you 
have gone mad." No sooner was Charles recovered than 
John met with a serious accident. Whilst in health he had 
carried himself and his earnings to more comfortable quar- 
ters he did not fail to receive home nursing causing 
renewed anxiety to his brother and sister. This was the 
last ounce, Mary, worn out with years of nightly and daily 
attendance upon a demented father and a hysterically par- 
aplegic mother, harassed by a close application to millinery, 
had been obliged to take an apprentice but was strained 
beyond physical endurance and worn down to a state of 
extreme nervous misery. About September 15, 1796, the 
family observed mental symptoms which had so increased 
by Sept. 21, that Charles early in the morning sought but 
failed to find Dr. Pitcairn." That afternoon Mary, seized 
with a sudden frenzy, snatched a knife from the table, pur- 
sued the apprentice when her mother interposing was 
stabbed, dying instantly. JMary was totally unconscious of 
her act. Aunt Hetty fainted with terror. The father was 
too feeble in mind for aught but confused impressions. 
Charles alone confronted the horror of the scene. After the 
inquest Mary was placed in a private insane hospital where 
she in a short time recovered. Such a combination of de- 
pressing factors constituting a proper aetiological moment 
would suffice, even in an organization with little or no 
morbid heredity, to produce a serious transitory frenzy with- 
out consciousness of the violent act. About twenty years 
ago 1 observed the following case:* 

The patient, a 23-years-oid single dressmaker had had 
maternal ancestors liable to "rush of blood to the head,*' 
from which the great-grandfather, grandfather and grand- 
uncle died. I saw this patient accidentally while called by 
her brother to attend the mother, who was suffering from 
the premonitory symptoms of cerebral congestion. The 
daughter had been watching her mother very faithfully for 



jdbyGoOglc ' 



Hygiene of Degeneracy. 383 

two nights and was much worn out. She had a quarrel with 
herbetrothed an hour before my arrival, after which she went 
up stairs to work at a dress which had occupied her for 
two days but which she found had been placed near the 
fire and two live coals had fallen on it. She burst into a 
violent rage, tore the dress to pieces and then attempted to 
smash the furniture. She was secured by her sister, but 
continued violt?ntly excited for the next hour at whicli time 
1 saw her. Then she was in a condition of frenzy, said I 
was so dark I must be the devil and made two attacks on 
me. Other than tliis she did not display any evidence of 
delirium or hallucinations but was very destructive and re- 
quired constant watching. I ordered her to be wet packed 
in a sheet and an enema given her. In the course oi an 
hour she 'fell into a deep sleep, on awaking from which two 
hours after, she was perfectly herself but had no recollec- 
tion of anything after her discovery of the dress being 
spoiled. She was very much ashamed of the language ad- 
dressed to me, having been told of it by her sister rather 
injudiciously. She had been previously a very good tempered 
girl and had never before given vent to such a violent fit of 
anger. Just previous to falling asleep her hands became very 
turgid, but by the time she awoke this condition of things had 
disappeared. 

Mary as will be seen later, had had from time to time 
after puberty slight mental disorders whose morbid nature 
she recognized but whose explosion she was able to prevent 
by exercise of will power. The recurrence of these untreated, 
established by a natural law of the nervous system the 
periodicity her psychosis later assumed. In his letters to 
Coleridge, Charles thus refers to her: 

My poor dear, dearest sister, the unhappy and uncon- 
scious instrument of the Almighty's judgment on our house, 
is restored to her senses; to a dreadful sense and recol- 
lection of what has passed, awful to her mind and impres- 
sive (as it must be to the end of life) but tempered with 
religious resignation and the reasonings of a sound judg- 
ment which, in this early stage, knows how to distinguish 
between a deed committed in a transient irenzy, and the 
terrible guilt of a mother's murder. I have seen her. I 
found her this morning calm and serene; far, very far, from 
an indecent forgetful serenity; she had a most affectionate 
and tender concern for what has happened. Indeed from 
the beginning, frightful and hopeless as her disorder seemed 
I had confidence enough in her strength of mind and 



jd by Google 



384 Jas. G. Kieman. 

religious principles to look forward to a time when even she 
might recover tranquillity. 

Again he says of her: — 

Mary continues serene and cheerful. Though I see her 
almost every day yet we delight to write to one another for 
we can scarce see each other but in company with some of 
the people of the house. 1 quote from memory what she 
wrote: I have no bad terrifying dreams. At midnight when 
I happen to awake, the nurse sleeping by the side of me, 
with the noise of the poor mad people around me, I have 
no fear. The spirit of my mother seems to descend and 
smile upon me, and bid me live to enjoy the life and reason 
which the Almighty has given me. 1 shall see her again 
in heaven; she will then understand me better. 

Subsequently he says: — 

My sister is quite well, but must not, I fear, come to 
live with us yet a good while. In the first place, because 
at present, it would hurt her, and hurt my father for them 
to be together; secondly, for a regard to the world's good 
report, for ( fear tongues will be busy whenever that event 
takes place. Some have hinted, one man has pressed it on 
me, that she should be in perpetual confinement. What 
she has done to deserve, or where is the necessity of such 
hardships I see not, do you,' 

After one year Mary was released to her brother 
Charles. It has been remarked by superintendents of insane 
hospitals that the soundest mental background of a family 
has often been placed under hospital care because of acute 
attacks while the most intrinsically egotistic insane member 
remains at large to annoy the community with "sanity." 
The Lamb family proved no exception to this rule. The 
egotistic John, to the tender nursing of whom, the mental 
break down of Mary was due, had the incredible brutality 
to suggest that she be confined in perpetuity to the criminal 
department of Bethlem. Charles Lamb with wise foresight 
but with deep charity even for John, writes this proposal: 

I know John will make speeches about it, but she shall 
not go. The good lady of the madhouse and her daughter, 
an elegant sweet behaved young lady, love her and are 
taken with her amazingly. And I know from her own 
mouth she loves them and longs to be with them as much. 
Poor thing, they say, she was but the other morning say- 
ing she knew she must go to Bethlem for life; that one 



jdbyGoOglC 



Hygiene of Degeneracy. 385 

of her brothers would have it so but the other would wish 
it not, but be obliged to go with the stream, that she had 
often, as she passed Bethlem, thought it likely, "Here it 
may be my fate to end my days" conscious of a certain 
flightiness in her poor head oftimes, and mindful of more 
than one severe illness of that nature before. Let me not 
leave one unfavorable impression on your mind respecting 
my brotiier. Since this has happened he has been very 
kind and brotherly but I fear for his mind. He has taken 
his ease in the world and is not fit to struggle with diffi- 
culties nor lias he much accustomed himself to throw him- 
self into their way. His language is already, "Charles you 
must take care of yourself, you must not abridge yourself 
of a single pleasure you have been used to, etc., in that 
style oftalking." But you, a necessarian, can respect a 
difference of mind, and love what is amiable in a character 
not perfect. He has been very good but I fear for his mind. 
Thank God I can un-connect myself with his and shall 
manage all my father's moneys In future myself if I take 
charge of Daddy. This poor John has not even hinted a wish 
at any future time even to share with me. The lady at 
this mad-hotise assures me that I may dismiss immediately 
both doctor and apothecary retaining occasionally a com- 
posing draught or so for a while and that there is a less 
expensive establishment in her house where Mary will not 
only have a room but a nurse to herself. You know by 
economy how much more even 1 shall be able to spare for 
her comforts. She will, I fancy, if she stays, make one of 
the family rather than one of the patients. The old and 
young ladies I like exceedingly and she loves them dearly 
and they, as the saying is, take to her very extraordinary, 
if it be extraordinary that people who see my sister should 
love her. Of all the people I ever saw in the world my 
poor sister was the most and thoroughly devoid of the least 
tincture of selfishness. I will enlarge upon her qualities 
poor dear, dearest soul in a future letter for my own com- 
fort for I understand her thoroughly. If I mistake not, in 
the most trying situation that a human being can be found 
in, she will be found. (I speak not with sufficient humility 
I fear but humanly and foolishly), she will be found I trust 
uniformly great and amiable. 

The form of the first attack of Mary was a melancholia 
with frenzy so intense as to destroy consciousness almost 
as completely as epilepsy. As it developed on a neurotic 
background it, like the psychosis of Charles, passed albeit 



jdbyGoOglC 



386 Jas. G. Kieman. 

more permanently into states of exaltation. Anent her 
insanity, Charles Lamb remarks: — 

Her ramblings often sparkle with brilliant descriptions 
and shattered beauty. She would fancy herself in the days 
of Queen Anne or George (. and describe the brocaded 
dames and courtly manners as though she had been among 
them in the best style of the old comedy. It was all broken 
and disjointed so that the hearer could remember little of 
her discourse but the fragments were like the jewelled 
speeches of Congrcve only shaken from their setting. There 
was sometimes even a vein of crazy logic running through 
them associating things essentially most dissimilar but con- 
necting them by verbal association in strange order. As a 
mere physical example of deranged intellect, her condition 
was 1 believe extraordinary; it was as if the finest element 
of mind had been shaken into fantastic combinations like 
those of a kaleidoscope. 

Mary's insanity soon became cyclothymia through the 
intensification of that neuropathic swinging round the circle 
between exaltation, depression and tranquillity already 
pointed out by Krafft- Ebing. The results in Charles Lamb who 
had just such a type ere puberty completion, treated, as all 
such cases should be, early, signiticantly demonstrate the 
beneficial influence of early insane hospital care. To Charles 
Lamb's regular, unworrying, systematic employment in the 
India House, together with the safety valve of emotional 
play in his literary incursions, added to his early treatment 
have been ascribed, and in no small degree rightly, his es- 
cape from the fate of Mary. In both there was a sound 
mental background. In both, the secondary ego survived 
bad heredity to an astonishing degree. Mary, under a ter- 
rible strain during puberty, finally broke down under the 
combined burden of bread winning, of nursing a paralytic 
hysteric, a dement and a nagging degenerate, into a cyclo- 
thymiac whose insanity lasted half a century. Had John 
Lamb and his wife been sent to a good insane hospital; 
and John Lamb, Jr., to a good general hospital; both 
of which even then were plenty in London, Mary would 
have been saved the years of suffering resultant on that mis- 
placed hurtful tenderness which treats the insane at home. 
Of Charles Lamb's heredity there remained in after life. 



jdbyGoOglC 



Hygiene of Degeneracy. 387 

stammering and paroxysmal attacks of migraine replaced at 
times by inebriety but in no small degree due to irregular- 
ities of diet partly owing to dietetic absurdities, then preva- 
lent. His essay on "Roast Pig" is significant evidence of 
ttiese last. Many of Lamb's letters display that gourmand 
rather than gourmet tendency which often aggravated his 
nerve symptoms. For forty years thenceforth Charles and 
Mary were to lead a life of mutual tenderness adorned by literary 
work eminently scholarly and humorous in the best Ben 
Jonson sense of delicate wit tempered by pathos. The 
Tales from Shakespeare do not read like the joint produc- 
tion of a sufferer from migraine and a periodically violent 
lunatic. No Nordau could assail the "Essays of Elia" as 
the realism of a degenerate. Nor in the tales for children 
is there aught mawkish or fetichly occult. Indeed these 
discourage all such tendencies. The literature produced by 
Charles and Mary Lamb was eminently sane and whole- 
some. It is of interest to note that neither Charles or 
Mary Lamb retained that fear of an insane hospital so 
cliaracteristic of the imperfectly recovered insane. The re- 
current insanity of Mary Lamb witnessed repeated pilgrim- 
ages from house to insane hospital by brother and sister. 
The first trusted her to medical care without dread. The 
original obligation that he should place her under hospital 
care when required was rigidly complied with by both. 
This arrangement Charles Lamb was not able to effect 
without difficulty, as there was considerable opposition to 
her discharge, but he satisfied all Vy his solemn promise 
that he would take her under his care for life. He kept 
his word, and many pleasant, very pleasant years they 
passed together though frequent returns of the psychosis, 
often made necessary confinement. During the intervals of 
her malady, Mary amused herself and assisted her brother 
in literary labors, writing poetry and letters to friends. She 
also superintended the domestic affairs of the house, and 
largely contributed to the enjoyment of the renowned sup- 
pers of the "Lambs."* 

■MrmotUIS ot Charles Lamb by Thm. Noon Tdtourd. 



jdbyGoOglC 



388 Jas. G. Kieman. 

Of her periodic mental disturbance Charles Lamb, May, 
1833, two years ere his death and nearly four decades after 
its onset, presents the following picture: 

Mary is ill again. Her illnesses encroach yearly, the 
last was three months, followed by depression most dread- 
ful. I look back upon her earlier attacks with longing. 
Nice little durations of six weeks or so, followed by com- 
plete restoration, shocking as they were to me then. In 
short, half her life she is dead to me and the other half is 
made anxious with fears and lookings forward to the next 
shock. With such prospects it seemed to be necessary that 
she should no longer live with me, and be flustered with 
continual removals; so I am come to live with a Mr. Wal- 
den and his wife who take in patients, and have arranged 
to lodge and board us only. They have had the care 
of her before. 

In February, 1834, he thus describes her condition: 

It is no new thing for me to be left to my sister. 
When she is not violent, her rambling chat is better to me 
than the sense and sanity of the world. Her heart is ob- 
scure, not buried; it breaks out occasionally; and one can 
discern a strong mind struggling with the billows that have 
gone over it. 1 could be nowhere happier than under the 
same roof with her. Her memory is unnaturally strong; 
and for ages past, if we may so call the earliest records of 
our poor life, she fetches thousands of names and things 
that never would have dawned upon me again, and thous- 
ands from the ten years she lived beford me. What took 
place from early girlhood to her coming of age principally 
live again (every important thing and every trifle) in her 
brain with the vividness of real presence. For twelve 
hours incessantly she will pour out without intermission, all 
her past life forgetting nothing, pouring out name after 
name to the Waldens as a dream; sense and nonsense, 
truth and errors huddled together; a medley between in- 
spiration and possession; what things we are. 

Talfourd states that when in December, 1834, Charles 
Lamb died, his sister was mercifully in a state of partial 
estrangement, which, while it did not wholly obscure her 
mind, deadened her feelings so tliat as she gradually re- 
gained her perfect senses she felt as gradually the full 
force of the blow, and was the better able calmly to bear 
it. For awhile she declined the importunities of her friends 
that she would leave Edmonton for a residence nearer Lon- 



jdbyGoOglC 



Hygiene of Degeneracy. 389 

don where they might more frequently visit her. He was 
there asleep in the old church-yard, beneath the turf near 
which they had stood together and had selected for a rest- 
ing place. To this spot she used when well to stroll out 
mournfully in the evenings, and to this spot she would 
contrive to lead any friend who came in the summer even- 
ings to drink tea and went out with her afterwads for a 
walk. At length, as her illness became more frequent and 
her frame much weaker she was induced to take up her 
abode under genial care at a pleasant house in St. John's 
Wood where she was surrounded by the old books and 
paintings and was frequently visited by her reduced num- 
ber of surviving friends. Repeated attacks of her malady 
weakened her mind but she retained to the last her sweet- 
ness of disposition unimpaired. She died May 20th, 1847. 
As Talfourd remarks, little could any one, observing Miss 
Lamb's habitual serenity of her demeanor, guess the calam- 
ity in which she had partaken or the malady which fright- 
fully chequered her life. She described herself on her re- 
covery from the first attfick as having experienced while it 
was subsiding such a conviction that she was absolved in 
heaven from all taint of the deed in which she had been the 
agent such an assurance that it was a dispensation of Provi- 
denceforgood thoughsoterrible, such asense thather moth- 
er knew her entire innocence and shed down blessings upon 
her as thoush she had seen the reconcilement in solemn 
vision, that she was not sorely afflicted by the recollection. 
It was if the old Greek notion of the necessity for the un- 
conscious shedder of blood polluted though guiltless to pass 
through a religious purification, had in her case been hap- 
pily accomplished so that not only was she without remorse 
but without other sorrow than attends on the death of an 
infirm parent in a good old age. She never shrank from 
alluding to her mother when any topic connected with her 
own youth made such reference in ordinary respects natural; 
but spoke of her as though no fearful remembrance was asso- 
ciated with the image; so that some of her most intimate 
friends who knew of this disaster believed that she had 
never become aware of her own share in its horrors. Tal- 



jdbyGoOglC 



390 Jas. G. Kiermn. 

foiird erroneously thinks it still more singular that in the 
' wanderings of her insanity amidst all the vast throngs of 
imagery she presented of her early days, the picture never 
recurred or if ever not associated with shapes of terror. 
But the acts of a frenzied melancholiac with dulled con- 
sciousness are rarely remembered. 

Miss Lamb* would have been remarkable for the sweet- 
ness of her disposition, the clearness of her understanding 
and the gentle wisdom of all her acts and words, even if 
these qualities had not been presented in marvelous con- 
trast with the distraction under which she suffered for weeks, 
latterly for months in every year. There was no trace of 
insanity discernible in her manner to the most observant 
eye; not even in those distressful periods when the pre- 
monitory symptoms had apprised her of its approach and 
she was making preparations for seclusion. In ail its 
essential sweetness, her character was like her brother's, 
while by a temper more placid, a spirit of enjoyment more 
serene she was enabled to guide, to counsel, to cheer him; 
and to protect him on the verge of the mysterious calamity 
from the depths of which she rose so often unruffled to his 
side. To a friend in any difficulty, she was the most com- 
fortable of advisers the wisest of consolers. Hazlitt used to 
say that he never met with but one woman who could rea- 
son, and had met with only one thoroughly reasonable, the 
sole exception being Mary Lamb. She did not wish, how- 
ever, to be made an exception to a general disparagement 
of her sex; for in all her thoughts and feelings she was 
most womanly keeping under even undue subordination to 
her notion of a woman's province, an intellect of rare excel- 
lence which flashed out when the restraint of gentle habit 
and humble manner were withdrawn by the terrible force 
of disease. Though her conversation in sanity was never 
marked by smartness or repartee, seldom rising beyond that 
of a sensible quiet gentle woman appreciating and enjoying 
the talents of her friends, it was otherwise in her madness. 

It is a singular comment on the "new woman" cant of 



jdbyGoOglc 



Hygiene of Degeneracy. 391 

the present day that the narrow conventionality of the 
early 19th century, more brutally restrictive in England of 
women of the middle classthan at any period before orsince 
in English speaking countries, should have restrained health- 
ful expression of intellectual power undoubtedly contributing 
thus to the recurring mental breakdown of Mary Lamb. Cer- 
tainly had she found an unrestricted outlet in remunerative 
literary labor in lieu of parsimoniously paid millinery, her 
intellect would have been preserved at a most critical time, 
and her relatives would have been much better cared for. 
The cant which would restrict intellectual women to house- 
hold duties, much better performed by the large mass of 
starving working women, seems as much a waste of energy 
as that which would employ a watchmaker in making horse- 
shoes. It is also a singular illustration of the persistence 
of brutal cant, that the same primitive spirit of revenge 
which called for the perpetual imprisonment of Mary Lamb, 
should call to-day for the similar imprisonment of insane 
homicides irrespective of the nature of the case. The same 
beneficient spirit of justice which, in the common law, dis- 
tinguishes between the liomicide committed in the heat of 
passion and the deliberate murder, would compel a distinc- 
tion between the homicide of acute states of dazed con- 
sciousness and the homicide of the epileptic or of the chronic 
insane. The one is an isolated phenomenon not likely to be 
repeated, the other is always an imminent possibility. The 
common law in this respect needs no amendment, but judges 
and the community need more instruction as to what law 
and justice are. The two careers of Mary and Charles 
Lamb illustrate how even under the burden of inherited 
degeneracy and the no less terrible strain of an environment 
entailing a fierce struggle for existence, a large amount of 
soundness of intellect and of morality may survive. They 
also illustrate the beneficence of physiologic atavism caus- 
ing continual attempts to regain a normal type lost for some 
generations. In Charles Lamb's career there is much to 
indicate that had dietetics been as well understood then as 
to-day much of his sufferings and so-called eccentricities 
might have been avoided. The childhood of both Mary and 



jdbyGoOglC 



392 Jas. G. Kteman. 

John Lamb illustrates how readily In minds of degenerates 
or of persons at a certain state of culture the germs of 
unwholesome atavistic beliefs are created to form the ba- 
sis of much that proves absurd and even dangerous in after 
life despite careful education subsequent to puberty. The 
two cases also illustrate very fully, since both Charles and 
his sister were ardent students of the older English drama- 
tists, and the older English literature how much wholesome- 
ness there lies in this as contrasted with works on emo- 
tional religion or dogmatic theology. Charles and Mary 
were both unquestionably devout but with a certain large- 
ness of view which proved a source of mental hygiene in 
pljce of a poison like most dogmatic theology and religios- 
ity. Undoubtedly Mary's religious views tended to comfort 
her when she discovered that she had slain her mother dur- 
ing a fit of insanity. Her mental state, however, differed 
decidedly from that moral anesthesia produced in certain 
insane by a hospital sojourn which makes them so delight- 
fully altruistic within the walls and so brutally egotistic 
without. Charles Lamb's mental breakdown which oc- 
curred at the decidedly critical period of puberty illustrates 
the benefit of hospital care and the folly of home treatment. 



DISCUSSION. 

In the dtscu^ion Or. Bannister remarked that Charles 
Lamb regarded his failings which he mentions himself, as 
pathological, Dr. Bannister considered Lamb as many times 
at least somewhat on the borderland of insanity. "1 think 
that was the case; is that not so, Dr. Kiernan?" 

Dr. Kiernan: The only marked psychic abnormalities 
were his drinking fits and these might be considered path- 
ologies because they sometimes took the place of fits of 
migraine when he was very much depressed. 

Dr. Bannister: The other point was the state of mind 
in which Mary Lamb and her brother kept, considering the 
family history, the degenerative taint in the family. 1 
think, though, that this is less uncommon than would be 



jdbyGoOgIC 



Hygiene of Degeneracy. 393 

supposed. I have in mind a case somewhat similaT to Miss 
Lamb's where a lady killed her husband and so injured her 
son that he was maimed for life. Here was a case of 
homicidal mania at all times when among home associa- 
tions; in the hospital she never manifested any of those 
traits. She had undoubtedly a perfect consciousness of her 
past and knew about the event that had sent her there. 
She had been sent home several times, but each time the 
homicidal mania had again seized her, and she finally died 
in the hospital after about twenty-five years' residence 
there. She was an optimist, she had the most amiable 
disposition, was very much beloved, though three weeks at 
her home would bring out homicidal tendency and make her 
unsafe. I have noticed the same thing in one or two other 
cases. The lack of egotism in the insane is not so un- 
common either, there are many cases, especially chronic 
cases where the altruism of the patient is most marked. I 
would suggest in order to get Dr. Kiernan's opinion that 
the state of mind in which Charles Lamb and his sister 
were, the cheerful, helpful state you might say, in itself 
had possibly something pathological in it, something a little 
abnormal. Would a person thoroughly normal, remember- 
ing the facts and fully appreciating the family history have 
been exactly as they were? Was there not some emotion- 
al anaesthesia in this case. 

Dr. Kiernan: I did not dilate on a number of inter- 
esting points in the paper because I thought these might 
be covered by the discussion. In the first place the lives 
of both these noted characters in literature impressed me 
after careful study, somewhat different from what they 
seem to have impressed Dr. Bannister. The cheerfulness 
to which he refers as pathological seemed to me rather the 
expression of a comparatively sound mental state resulting 
possibly from atavistic factors. Certainly I have studied a 
good many of so-called periods of degenerates and should 
be very much inclined to agree with Dr. Bannister that a 
large number of seemingly sound periods are decidedly ab- 
normal. Here however, the sound periods were marked by 
phenomena that were exceptional in other degenerates. The 



jdbyGoOglC 



394 Jas. G. Kiervan. 

fact that Charles Lamb and the sister with about the same 
type living in the world, not in an asylum, were able to 
recognize the morbid nature of their insane acts and also 
to recognize the chief defect underlying it, seems to me to 
indicate a degree of freedom from egotistic logic that could 
only pertain to a sound mental state. Now I do not say 
that Lamb was strictly speaking free from what might be 
called mental defects during the long life that passed after 
the first attack but these were the confused and irritable 
states due to migraine and they were often replaced by 
inebriety, but between these periods which he was able to 
control, Lamb was decidedly sane in his intellect. A large 
number of the insane or degenerate, or the hereditarily de- 
fective take the ground that genius must be a neurosis and 
thereby exalting or palliate their deficiencies. While it may 
be admitted that genius can occur in the neurotic and that 
one-sided genius may be an expression of that defect which 
shows itself in consequence of atrophy to a certain extent, 
still at the same time that class of beings will not recog- 
nize any possibility of the difference between the greater 
genius and insanity. But should one read Lamb's essay on 
the sanity of true genius and not know anything about 
his mental state, know nothing of his family history, the 
first impression that it would make would be precisely the 
same that it made on me, that the man must be entirely 
sane. Go through his essays carefully, there will be found 
a mental balance that from the degenerate standpoint is re- 
markable. Compare his essays with any of those of the 
great degenerates and the soundness is somewhat astonish- 
ing. The lack of egotism is wonderful in comparison with 
the dour egotism and misoneism of the sane Carlyle. Go 
through Lamb's whole literary career and the insanity is 
not expressed at all. In that particular he differs very 
markedly from others. De Maupassant for example, wrote 
his last novel practically under the charge of Dr. Blanche. 
He unconsciously reproduced a whole chapter from a form- 
er work and used that as the ground work of a new novel 
which was decidedly insane apart from that chapter. Cowper 
shows the abnormality to a remarkable degree. Take "The 



jdbyGoOglC 



Hygiene of Degeneracy. 395 

Castaway" with its extreme gloom and one would deem the 
man a melancholic. His intensely humorous "John Gilpin's 
Ride" seems the product of an exalted period. Many a man 
in his exalted period would have as ridiculous images as there 
were depressed ones in "The Castaway." Take even a 
writer like Lucretius, Here is a materialist, a free thinker, 
a man who believes in evolution. He is stricken with in- 
sanity, part of his poem is composed in that condition and 
the man goes back to the lumber room of fetichism treat- 
ing of the astral body and ghosts remaining around places 
of murder as if these were natural phenomena. Here are 
traces of the man's defect but in Lamb's work we can find 
none. Even if Nordau's method be applied none could be 
found. Nordau finds in the natural odors, that Zola de- 
scribes (in connection with a particular scene whose de- 
scription must be expected in a realist which is an expres- 
sion not of the man's own individuality but of the environ- 
ment he is picturing) an evidence of the peculiar abnormal 
liking for odors of the idiot. But even considering things 
thus there can not be found in the Essays anything ab- 
normal. On going through Lamb's Tales of Shakespeare, 
and those sound stories told for children no one would ever 
be led to remember the mental characteristics of the writ- 
ers. The Tales of Shakespeare are excellent without be- 
ing goody-goody for children. It seems to me, therefore, 
that the mental states of both brother and sister, in what 
was called the sound period, was comparatively healthy. 

With regard to the question of drunkenness. Consider- 
ing the era, the fact that Charles sometimes lapsed, that 
inebriety sometimes took the place of the migraine period 
is not astonishing. It is to be expected. It was the famous 
period when most everybody was a drinker; it was the era 
that wound up with the opposite extravagance of the Neal 
Dow period. I can remember relics of that era when I was 
a boy of ten in the districts that are now free from any 
contamination of alcohol theoretically; where the room of 
the country grocer had its bottles with medicinal mixtures, 
gin and tanzy, or gin and wormwood, (which would cor- 
respond ideally with absinthe) and there were the usual 



.dbyGoot^le 



396 Jas. G. Kienian. 

drinks besides. That was fifteen years after Mary's death. 
Before tliat, according to Hawthorne's picture, New England 
was in a heavy drinking period. In England just up to 
about the forties men prided themselves tremendously on 
being three bottle men, that is, on being able to drink three 
pints of wine at a sitting and a man was not thought very 
much of who was not a three bottle man. So the occasional 
lapse was hardly a defect because it corresponded to the 
environment. In dealing with these defects this must be 
taken into consideration. 

The career of the two are interesting from the stand- 
point of training children. If Charles Lamb had been prop- 
erly trained, in all probability he would have gone through 
life without that attack and without probably anything but 
a slight tendency to migraine or something of that kind. 
Certainty Mary would have broken down under that strain 
if there was a sufficient etiological moment, without any 
taint at all. Of course in the periodical condition crops out 
the insane taint and furthermore in the irregular circular 
condition. Take a child of the stamp, these two have 
depicted themselves with a tendency to terror, and a tend- 
ency to look at everything from the standpoint of terror and 
give them a good sensible mother or substitute for the 
mother the relative who comes and takes Mary away for a 
restful period in the country, substitute such a person for 
the mother, and the probability is that botli of those child- 
ren could have been favorably brought up. The two careers 
teach a more optimistic lesson than that usually received 
from degenerates. 



jdbyGoOglc 



TIC CONVULSIF REPLACING SUPRA- 
ORBITAL NEURALGIA. 



By Harold N. mover, M. D., Chicago. 

FelJow of the Chicago Academy of Medicine; Adjunct Professor of Medicine, 
Rush Medical College. 

f^ K. is thirty-two years of age and is married. His 
^^* previous health history is good. He has had no 
venereal disease, and has been temperate. 

The mother of the patient had a twitching of the left 
side of the face when 52 years of age. The spasms are 
described as frequent but not continuous. This spasm lasted 
for four years and then ceased as suddenly as it began. 
The spasms were not accompanied by pain. Six years after 
the spasms ceased she began to have pain in the left side 
of the face, this was preceded by vertigo, which was aggra- 
vated by movement. The facial neuralgia when it first 
began was referred to the teeth which were all extracted 
without relief to the pain. About two years ago the infra- 
orbital nerve was resected which has been followed by 
relief from the more severe attacks of pain. There is some 
stal;ic ataxia and vertigo is increased when lying down. 
Hearing is 50 per cent, better in the left ear than the right. 

This patient's illness began in 1887 when he suffered 
severely from supra-orbital neuralgia. The attacks would last 
from one to four weeks and he thinks they were brought on by 
taking cold. After five years the attacks of pain ceased and 
the spasms began in the left eyelid, at first they were few 
in number but they gradually increased in severity and 
extended so as to involve all the muscles of the face. They 
have not affected the muscles of the neck. The spasms are 

[397] 



jdbyGoOglC 



398 HaroUi N. Moyer. 

severe lightning like and the contractions succeed each other 
rapidly. The whole side of the face is distorted when the 
spasms are on. In the interval no change can be noted in 
the appearance of the face. The patient states that at the 
moment the spasm begins, there is a feeling as though there 
were cotton in the left ear. The progress of the disease 
has been variable for weeks, the spasms would be frequent 
and severe, again they would be rare and of short duration. 
The disorder had become markedly worse during the past 
five years. 

There is no central nervous disturbance. Sensation of 
the face and inside of mouth normal. The facia) reflex is 
present and not exaggerated. 

The eyes were kindly examined for me by Dr. Alfred 
Hinde. He reports the visual fields, color sense and eye- 
grounds normal. Vision right eye 20-20, left eye 20-30. 
Left slightly hypermetrophic but not improved by glasses. 
The external muscles balance perfectly. There is diminished 
accommodation for his eye (+3.75 D) the same in both eyes. 
This loss of accommodative power which is equal to that of 
a man 43 years of age. Dr. Hinde thinks, is due to a 
weakness of the ciliary muscle not connected with the tic. 

Taste and movements of tongue are normal. Hearing 
■ is equal in both ears. Some of his teeth in the left upper 
jaw are decayed. The electrical reactions are normal and 
the same on both sides. 

An interesting point in this case is the direct heredity. 
The only other reference in the literature I have been able 
to find, is that reported by Rosenthal (Diseases of the Ner- 
vous System, page 199} of the case of a mother, son and 
daughter and two other maternal relatives who had the 
disease. Another is the relation of pain to the disorder. 
The mother's tic was succeeded by a severe facial neuralgia. 
The interval between the two disorders was about six years. 
In the boy the tic was preceded by attacks of supra-orbital 
neuralgia lasting five years which gradually subsided as the 
tic became more pronounced. 



jdbyGoOglC 



THE OCCIPITAL LOBE AND MENTAL 

VISION.* 



By J. SOURY, M. D. 



THESE articles, investigating comprehensively tlie rela- 
tions of the retina, the optic path, and the occipital 
lobe to the completed visual act, comprise the best short 
summary of our knowledge of this subject that we have 
seen. The author treats his theme under two heads. He 
follows the path of the visual impression first from the retina 
to the primary sub-cortical centers, and second, from the 
primary optic centers to the cortex of the occipital lobe (the 
calcarine region end cortical retina). Concerning the inti- 
mate construction and physiology of the optic nerve, he 
says, "the optic path as a whole runs from retina to cortex, 
but contains two parallel systems of conductors (a) cen- 
tripetal, (b) centrifugal in direction (Ramon y Cajal)", 
The former arise in the axis-cylinder prolongations of the 
large cells of the retina. They arborise freely with the pro- 
toplasmic expansions of the principal groups of nerve cells 
in the external geniculate bodies and pulvinar of the optic 
thalmus. From the intercalary cells of these ganglia other 
axis-cylinder processes traverse the posterior end of the 
internal capsule, continue as the white sagittal substance 
(or optic radiations of Gratiolet), and end in the nervous 
feltwork of the fifth {and third) layer of the occipital cortex. 
There a new system of neurons forms connection with the 

*BriiM. Aulunn. 1S96 (from Rn 
1895: Ftbnuiyand March. 1896). AbstncI by t 
w/ocr. April. 1897. 

[399] 



jdbyGoOglC 



400 J. Souty. 

other cells of the cortex, more particularly with the giant 
solitary cells. 

The centrifugal fibers start with the axis-cylinder pro- 
cesses of the pyramidal cells of the cortex, and arborise 
with the nerve cells of the superficial gray matter of the 
anterior quadrigeminal tubercles. The processes from these 
ganglia again terminate in the nervous feltwork of the 
retina. The giant solitary cells of the occipital cortex are 
found to atrophy after section of the posterior segment of 
the internal capsule. 

Clinical evidence shows that lesion of the anterior quad- 
rigeminal bodies is not essentially injurious to vision, but 
that it does involve disturbance of the eye movements and 
of pupillar innervation (Monakow). In the lower animals, 
even in certain mammals, these ganglia are of main import- 
ance to vision, as compared to the external geniculate bodies 
and pulvinar of the thalmus. The fibers which they con- 
tribute to the optic tract in man are relatively insignificant, 
though the iridic reaction appears to be governed by these 
bodies. Mendel's detailed experiments point to the ganglion 
habenula; as the precise center of the pupillary reflex. 
Iridectomy seems to invariably produce atrophy of this 
ganglion. M. therefore defines the path of the reflex as 
optic nerve and ganglion habenul^e of same side, thence by 
posterior commissure to nucleus of Gudden and so to the 
fibers of the oculomotor trtink. 

The visual acuity of the macula is said, by Soury, to 
depend upon the delicacy with which each cone transmits 
its excitation to a bipolar cell, this again to one protoplas- 
mic arborisation of the ganglionic layer. The autonomy of 
the macular region persists throughout the optic nerve to 
the cortical centers; and the preservation of central vision 
in the majority of cases where (as in hemianopsia) the 
entire visual cortex is destroyed on one side, indicates that 
each macula is connected with both hemispheres. The 
importance of the sub-cortical centers must be remembered. 
They are the ganglia of origin for the optic nerve — the 
posthouse where impressions conveyed by the retinal fibers 
are transmitted to other couriers. 



DigiLizedbyGoOglc 



The Occipital Lobe and Mental Vision. 401 

In regard to the cortical center of vision, M. Soury 
adopts the position of Henschen, stating that the visual area 
is much more extended than the centers for sensations of 
light and color. Late anatomical methods have thrown 
more light on the functions of the nerve centers. Thus it 
has been shown that in cases of blindness involving wide- 
spread degenerations the geniculate bodies alone are in direct 
relation with vision. The fibers of the optic nerve which 
pass into the pulvinar of the thalmus, the anterior quad- 
rigeminal bodies and the temporal and the parietal lobes are 
not visual. 

Degeneration of tiie pulvinar produces no hemianopsia 
when the geniculate body is intact. The anterior quad- 
rigemina may submit to grave lesion without any disturb- 
ance of vision. The pulvinar and quadrigeminal bodies are 
possibly reflex optic centers — in man they probably do not 
contain a single visual fiber. The geniculate bodies alone 
are in relation with vision, lesion of them invariably pro- 
ducing hemianopsia. Certain forms of sub-cortical hemi- 
anopsia may indeed be accompanied by pulvinary lesion, 
but the latter is not causative, it is only coincidental. The 
actual cause of blindness is lesion of the external geniculate 
body. Destruction of this ganglion determines an almost 
total disappearance of the bundle of Gratiolet, through which 
pass the visual fibers from the ganglion. The symptoms 
which originate from the thalmus are quite different, e. g., 
motor troubles of expression — imitative, involuntary, auto- 
matic, etc. In man, the anterior quadrigeminal tubercles are 
equally deprived of the importance which Griesinger attri- 
butes to them in vision. In fact, the optic lobe in man is 
no more than a reflex center. Nor has the inferior parietal 
lobule or angular gyrus any more direct relation with vision. 

The anatomical structure of the catcarine cortex {though 
differing from the rest of the occipital lobe, not merely in 
the thickness of the molecular layer, but also in its devel- 
opment of horizontal fibers forming the band of Vicq d'Azyr) 
is not special to the fundus of the fissure. The same extends 
for several m. m. along the two lips of the calcarine fissure, 
the superior of which belongs to the cuneate, the inferior to 



jdbyGoOglC 



402 J. Soury. 

the lingual lobe. It is to be expected that sucli identity of 
structure in either convolution should result in identity of 
function, and Hun adduces a case in which atrophy of the 
superior lip of the cakarine fissure produced hemianopsia of 
the inferior quadrant of the visual field on both sides. 
Wilbrand shows that the lower lip corresponds with the 
upper visual field. There wdtild thus appear to be projec- 
tion of the retina upon the cortex of the occipital lobe, as 
contended by Munk and disputed by Monakow. Henschen 
accepts it and proposes the name of "calcarine retina" for 
the part of the cortex of this fissure at which, according to 
him,, there is a projection of the elements of the peripheral 
retina, via the visual fibers of the optic nerves chiasm, 
tracts, and optic radiations. The macular bundle, though 
lateral in the papilla of the optic nerve, is certainly central 
in the chiasma and tract. The central and peripheral por- 
tions of the cortical retina would lie in the anterior and 
posterior parts of the cortex of the calcarine fissure (Hen- 
schen). Sachs, on the other hand, has a case which does 
not correspond with this somewhat restricted cerebral local- 
ization of the macula lutea. Both Henschen and Wilbrand 
believe that each half of either macula lutea is in connec- 
tion with both cerebral hemispheres, while the macular 
fibers also undergo partial decussation in the chiasma and 
are divided into direct and crossed bundles. 

The preceding observations refer to the "cerebral re- 
tina," and not to the much larger region of the ''visual 
area," which is the anotomical substrate of mental vision. 
Willie the region on which visual impressions are projected 
is very linuted, that corresponding with visual representa- 
tions is vast, and may very likely involve the convexity of 
the occipital lobe and the angular gyrus. The seat of per- 
ception and of representation occupy distinct positions on 
the occipital and parietal lobes. Nothing is certain, how- 
ever, beyond the fact that there is a cortical center of vis- 
ual perception, and that its lesion entails cortical hemia- 
nopsia. 

Soury joins Monakow in emphasizing the importance of 
the primary optic centers interposed on the optic path, such 



jdbyGoOglC 



Tkf Occipital Lobe and Mental Vision. 403 

as the external geniculate body (in which the majority of 
the visual fibers terminate and lose their individuality), a 
fact too often overlooked in schemata, which are construct- 
ed as if the projection bundles radiating over the visual 
sphere were the direct prolongation of the optic fillets. 
This has important bearings upon the doctrine of retinal 
projection {supra). The ansrtomical conclusion appears to 
be that not the retinal fibers, but the fibers of the external 
geniculate body are projected upon the occipital lobe. 
Soury and Monakow disallow the direct localized projection 
of impressions from the macula lutea on the cortex, Soury's 
theory being that the macula fibers are distributed to all 
parts of the external geniculate body, and thus transmit 
their impressions to every part of the cortical center. This 
would account for the partial preservation of central or mac- 
ular vision in most cases of cortical hemianopsia. 

M. Soury concludes from all these facts relating to the 
cortical localization of bilateral homonymous hemianopsia, 
that Ferrier is mistaken and Munk correct in their respec- 
tive views concerning the cerebral center of vision. Munk 
attributes the transitory hemianopsia consequent on the ex- 
tirpation of the angular gyrus to the inflammatory reaction 
of the occipital lobe, and especially to the compression (not 
destructive lesion) of the optic radiations of Gratiolet and 
Wernicke which pass under the angular gyrus and inferior 
parietal lobule on their way to the cortex from the external 
geniculate bodies. It is thus that all lesions of the angular 
gyrus, etc., usually reach the projection bundle of the visual 
fibers. Should this be destroyed and the message thus in- 
terrupted from the last sub-cortical station to the occipital 
cortex, nothing can avert absolute cortical, hemianopic 
bhndness in the two halves of the retina implicated. 



jdbyGoOglc 



The Civic Duties and Responsibilities of 

the Physician to his Community, 

State and Nation.* 



BY JOHN PUNTON, M.D., Kansas City, Wo. 



Professor of Nervous and MenUI Diseases, University Medical College; 

Neurologist to All Saints, German-Scarrltt, K. C F. S. 4 M., 

and Mo. Pac. R. R. , Hospitals, etc. 

THE closing days of the 19th century are characterized 
by a feverish activity in all departments of learning 
unsurpassed in any previous period of the world's history. 

Perhaps in no department is this more conspicuous and 
striking than is found associated with the science of medi- 
cine. In its voluminous annals there never was a time 
when it was capable of scoring so many brilliant victories 
over the enemy, death, and its allied forces as the present. 
Indeed so remarkable has been the changes that our very 
proficiency is already threatening us with dire disaster and 
our greed for scientific development and attainment has be- 
come so very morbid that it is actually furnishing the 
means for our own suicide. 

Moreover the medical profession taken as a whole was 
never in a more perturbed and unsettled state or more en- 
vious and jealous of each other's welfare than now. 

Hence the former respect and influence which not only 
characterized but was willingly granted the profession by 
the laity, has gradually been withdrawn, until to-day the 
practice of medicine is simply regarded by them, as a mere 
business, trade or commercial calling, 

•Read by Kile before Ihe Missouri Slate Medical ASMCialton. MiQ> 20. 1897. il St 
Louis. Mo. 

[404] 



jdbyGoOglC 



Civic Duties and Responsibilities. 405 

In view of such facts it is fitting that we take time to 
enquire into some of the causes which has led up to this 
unfortunate state of affairs and see if we cannot devise 
some means or methods to regain our former social pres- 
tige and standing, beside elevate our ethical standard to- 
ward each other. 

In the past the doctor was recognized in every com- 
munity as the most influential citizen in addition to his 
purely medical skill and knowledge. While this may pos- 
sibly be true in some notable exceptions to-day, yet they 
are so very rare that the great mass of our profession in 
every city and community have not as much relative influ- 
ence and importance as formerly. Indeed the term "Doc- 
tor" has become so very common andits application abused 
to such an extent that the dignity and respect which form- 
erly belonged to our profession has lost much of its signifi- 
cance and value. 

In tracing the earlier history of our country it is sur- 
prising to find the power and influence wielded by the 
members of the medical profession in every community. 

Whenever a step in advance was contemplated the 
doctor was invariably appealed to for his wise counsel and 
support and the name of some honored member of our pro- 
fession was associated with every local movement in which 
the community as a whole were interested. 

Closely allied to him were members of both the pro- 
fessions of law and theology and much of what we are to- 
day we owe to their united efforts. 

But who can deny the fact that the three so-called 
learned professions have lost much of their former social 
prestige and standing, and to-day they do not enjoy the 
same relative importance and influence they once did. 
More especially is this true of the medical profession taken 
as a whole, although undoubtedly there are notable excep- 
tions to this common rule. 

It is interesting, therefore, at this juncture to listen to a 
layman's criticism and see ourselves as viewed through the 
p iblic eye, tor aft?r all it is to persons outside of our own 
ran'ns that wl- must mainly depend for our support and 



jdbyGoOglC 



406 John Punton. 

their advice should certainly be of some interest and value 
to us in the correction of our mistakes. 

For this purpose I cannot do better than call your at- 
tention to some remarks made by no less a person than 
Mr, Cleveland, ex-President of the United States, in his 
recent speech to the members of the New York Academy 
of Medicine, in which he justly criticises our present meth- 
ods and undertakes to give us good reasons for ogr present 
deterioration, and certainly he is in a position to know 
something of our failures as well as our successes. 

After paying a very graceful tribute to the village doc- 
tor of fifty years ago, he adds: "The village doctor was not 
only our physician but he was a man of influence in all 
the neighboring affairs. In every matter of importance that 
concerned the good of the community, he was at the front. 
He was president of the village or represented his town in 
the county board of superiors and if he was ever late in 
visiting his patient, it was because he lingered at the post- 
office to discuss the political situation. Thus he joined 
with the performance of professional duty, a discharge of 
the obligation of citizenship. We cannot but think that the 
discoveries arid improvements in medical practice which we 
now enjoy are dearly bought if the members of the pro- 
fession in their onward march have left behind them their 
sense of civic obligation and their interest in the general 
public welfare. While thus suggesting the need of your 
influence in legislative circles for the accomplishment of re- 
forms related to your profession, you will, 1 hope, permit me 
in conclusion to enjoin upon you the duty of an active and 
general interest and participation in public affairs for the 
promotion of your country's good in all its phases. Never 
did patient need your medical treatment more than the 
body Politic now needs the watchful care of your patri- 
otic and disinterested citizenship." 

You will observe that the burden of Mr. Cleveland's 
remarks is to the effect that as a profession we are sadly 
deficient in our civic duties and responsibilities to our com- 
munity, state and nation. In other words, we are in a 
certain sense, disloyal citizens, that our greed for scientific 



jdbyGoOglC 



Civic Duties and Responsibilities. 407 

attainraent consumes all our time and causes us to become 
intensely selfish, hence we forget all about our obligations 
as citizens, that we take no interest whatever in public af- 
fairs unless it be for individual, financial benefit, that the 
large and generous public service, which was formerly a 
marked characteristic of our professional life has entirely 
been withdrawn and if by any chance we are found in the 
field of politics it is largely for individual revenue. 

I trust in quoting these remarks of Mr. Cleveland's 
and commenting on them in this way that I may not be 
accused of urging upon the physician the necessity of be* 
coming politicians in the commonly accepted sense of the 
word, far from this, for if there is anything that 1 despise 
more than another it is the doctor who is more proficient 
in politics than medicine and who can always find time to 
attend political gatherings but has never been known to 
attend a medical convention much less read or write a 
medical essay. 

But there is a sense in which every physician should be- 
come known as a politician, by taking especial interest in 
public affairs which directly pertain to his obligation as a citizen 
and no amount of professional pride or interest in his spe- 
cial scientific work should rob him of this great duty. It is 
not only expected but required of every American citizen 
that he be willing to bear his share of the public burdens 
and take an active participation in the body politic, and 
physicians form no exception to this recognized duty. That 
we as physicians fall short of our duties and privileges in 
this direction is idle comment and much of our present de- 
terioration is undoubtedly due to this very cause. Hence 
the criticisms of not only Mr. Cleveland but others who 
make the same accusations, are in my opinion Just and fully 
deserving and it behooves us, not only as citizens, but as 
physicians, to become more generous in the public service of 
our community, state and nation. 

In the general administration of public affairs, there are 
sociologic problems presented in every community which ap- 
peal to the knowledge and best interest of every department 
of life. 



jdbyGoOglC 



408 John Punton. 

Many of these are of a purely medical character and le- 
quire the very best talent in our profession to solve them 
correctly. Unfortunately many of the more important of 
these are wholly ignored and allowed to pass by from year to 
year on the principle that what fs everybody's business is 
no one's business. Others are referred to very incompetent 
persons and when the verdict has been rendered, we look at 
each other and cry shame. For instance, in our own city the 
personnel of the county court consists of three non-medical 
men and yet often some of the most perplexing questions 
pertaining to insanity and other medical questions are nec- 
essarily referred and left entirely to their judgment for solu- 
tion. As well might you ask a layman to detect endocard- 
itis who had never listened to the normal heart sounds, as 
to expect these gentlemen to solve such difficult medical 
problems arightly. 

Then again the education of our children demands the 
interest and attention of the medical profession, for I am 
convinced that public school education ought not to be left 
solely in the hands of the pedagogue; but that it has a 
medical aspect of the highest importance. For instance, it 
has been demonstrated beyond a doubt that the medical out- 
put of the pupil is directly related to his height, weight 
and physical measurements and that there is a physical 
basis for precocity on the one hand and mental dullness on 
the other. Many a child is compelled to sacrifice its consti- 
tution for what is now deemed its educational necessities. 

In a paper (see Neuropathic Constitution and Educa- 
tion as a Factor in the Causation of Nervous Diseases) which 
I read before the local medical society four years ago, I 
called attention to the fact that it' was my firm conviction 
that a wisely selected medical board should be appointed 
in every city and town whose duties should t>e to visit the 
public schools and inspect the pupils and determine their 
physical condition as well as their capacity to study, be- 
side pass on the sanitary condition of the building. This 
statement which at the time was received in the light of a 
joke, nevertheless, strange as it may appear, was actually 
put in practical operation, inside of twenty months, in no 



jdbyGoOglC 



Civic Duties and Responsibilities. 409 

less a place than the so-called center of American culture, 
viz., Boston, and to-day it affords me pleasure to present a 
few extracts from the first report just issued of the medical 
inspection of Boston public schools. The schools were vis- 
ited daily and all the children who complained of illness or 
who appeared ill were examined. 

"For fourteen months ending December 3lst, 16,790 
pupils were examined, 10,737 of whom were found to be 
ill; 6,053 were found not to be ill and 2,041 of these were 
too ill to remain in school for the day. There were 77 
cases of diphtheria, 28 cases of scarlet fever, 116 of 
measles, 28 of chicken-pox, 69 of pediculosis, 47 of scabies, 
47 of mumps, 33 of whooping cough and 8 of congenital 
syphilis in children, sitting in their seats and spreading 
these diseases to other children. The remaining 10,372 
sick children were suffering from a large variety of diseases." 

"These results justify the work so far and show the 
need of extending it." A corps of medical inspectors suffi- 
ciently large to permit an intelligent physician to spend at 
least a few minutes daily in every school room, would de- 
tect many cases needing attention, yet not apparent to 
the teacher. Much of the sickness and enfeebled state of 
school children is due to the condition of their school rooms. 

New York City has also lately followed in the wake of 
Boston by appointing medical inspectors of public schools 
for the purpose of reducing the number of contagious dis- 
eases. Now 1 contend that what is good for Boston and 
New York is good for St. Louis and Kansas City, indeed 
every large or small city all over the country and it is our 
business to insist upon its enforcement. 

Then again in state medicine very little interest is 
now taken by our profession in matters which are purely 
medical and we can hardly expect our legislators to formu- 
late and pass laws, the necessity of which they are largely 
ignorant of. It is our business and duty to inform them 
and call their attention, say for instance, to the needs of 
certain of the helpless and afflicted classes who by virtue 
of their ailments are unable to help themselves. 

In a paper (See Medical Review, St. Louis) read before 



jdbyGoOglC 



410 John Punton. 

the state association three years ago, 1 urged the necessity 
of state provision being made for the helpless class known 
as the feeble-minded. All present agreed that it was a 
great and growing necessity but like many other similar 
questions, no steps were taken' to secure it. In this state 
aione there are at least one thousand of these poor, afflict- 
ed, feeble-minded children who are not only burdens to 
themselves, but also to those who are now compelled to 
care for them. The majority belong to families who are too 
poor to properly provide for their comfort. What is sadly 
needed in Missouri is a heme for these poor creatures fur- 
nished by the state. It is to the medical profession that they 
naturally look for aid and support and it is our duty to cham- 
pion their cause and insist on the needed state provision be- 
ing made for them. Moreover, special state provision for epi- 
leptics have been for some time a recognized need in this 
state. 

There are at least two thousand helpless epileptics in 
Missouri who instinctively turn to us for sympathy and help. 
Modern medical science teaches us that the state insane 
asylum is no suitable place for the confinement of such 
patients. What is sadly needed is a home specially provided 
for their exclusive care. Many states of the union have 
already made such provision and Missouri can well afford to 
be as humane and philanthrophic as other states. 

In recording one need after another, I fear you will 
accuse me of asking too much at one time but this is simply 
a sad reflection on our past negligence of duty. Our inter- 
est in these helpless invalids is only aroused spasmodically 
and then the attack does not last long enough to* accomplish 
anything. Mr. Cleveland strikes the key note of our true 
situation when he says; "If laws were needed to abolish 
abuses which your professional investigations have unearthed, 
your fraternity should not be strangers to the agencies 
which make the laws. Let me also remind you of the 
application to your case of the truth embodied in the homely 
injunction, 'If you want a job well done do it yourself.' 
If members of your profession were oftener found in our 
national and state legislature assemblies ready to advocate 



jdbyGoOglC 



Civic Duties and Responsibilities. 411 

the reformatory measures you have demonstrated to be 
necessary, the prospect of your bestowal upon your fellow- 
men of the ripened results of your professional labor would 
be lighter and nearer." 

How much plainer could the truth be stated to us by 
one who knows our serious dirilection of civic duties? The 
recent failure of the state board of health to gain legal rec- 
ognition for the enforcement of an advanced standard of 
medical education is a sad reflection on our waning power 
and influence and is simply a glaring illustration of how 
completely we are at the mercy of shrewd politicians and 
the willingness with which we succumb to such shameful 
treatment. 

On the other hand the legal indorsement of guackery 
shows at once what can be done by paying heed to Mr. 
Cleveland's advice, for this was undoubtedly accomplished 
by political influence and proves conclusively the great and 
growing need of adding to our list of standing committees in 
our state society, a special one on medical legislation whose 
duties should be to look out for the possible enactment of 
such laws by statesmen who are more or less ignorant of 
their true motive or merit or even fraudulent basis. 

To be of value such a committee should be furnished 
with all the authority and power to employ proper counsel 
to defend ourselves from such impositions and the expense 
attached should willingly be granted from the general fund 
or subscribed pro-rata by the membership of this associa- 
tion. While we deplore the inroads made on the sanctity 
of our profession by such intruders, I am one of those who 
believe that we as a profession can assert enough power 
and influence even yet in Missouri, to counteract any such 
legislation, providing we act as a unit, and I believe we can 
secure for ourselves any needed reasonable legislation that 
we indorse as being worthy. 

Another illustration which aptly pictures our present 
political weakness was the recent appointment of Homoeo- 
paths to take charge of the state insane asylum at Fulton, 
Mo. This movement called forth at the time more interest 
than is usual among the profession but in spite of the 



jdbyGoOglC 



412 John Punton. 

vigorous protest by ourselves and others the governor of this 
state proceeded to appoint a homosopathic staff, thus wrest- 
ing from us one of the oldest institutions of the state. In 
making this statement I do not intend to convey the idea 
that I am opposed to homceopaths treating the insane, hut in 
view of the fact that our state insane asylums are now to 
some extent at least overcrowded, this could easily be 
obviated by appropriating sufficient means to found a new 
insane hospital for the exclusive use of the homceopathic 
physicians. 

The present action of the governor is even more 
deplorable when we remember the relative strength of the 
two medical bodies in the state. Out of about five thous- 
and physicians less than four per cent, are homoeopaths. 
No wonder the laity loses confidence in our importance and 
doubts our ability to even maintain our own cause. This 
gross lack of interest in public affairs is also largely the 
responsible agent for the present unsettled condition of the 
medical profession and leads up to the formation of all kinds 
of un- professional conduct and shady schemes in which 
shrewd business men often hire out physicians as it were, 
under cover of charity while many of the more ethical 
members of our profession look on in amazement and regret 
that such things could ever exist. Time will not permit 
further enlargement of the many civic duties we owe our 
community and state but I cannot close this paper without 
a brief reference to a duty we owe as citizens of this 
glorious republic, to our nation. 

It has been long conceded that the medical profession 
could materially enhance its usefulness as a public bene- 
factor if it was properly represented in not only municipal 
and state affairs but also those of the nation. It has been 
suggested therefore, that we insist on recognition by urg- 
ing upon those who have the power to create a National 
Medical Bureau like that of law; and thus insure for the 
science of medicine a place in the national cabinet. In this 
connection 1 cannot do better than emphasize the wise 
counsel offered by our friend, Dr. C. H. Hughes, of St. 
Louis, in a recent issue of the ALIENIST AND NEUROL- 



jdbyGoOglC 



Civic Duties and Responsibilities. 413 

OGIST, when he says: "As a physician, a practitioner of 
the healing art, a teacher of medicine in school and with 
journal, 1 dare to proclaim that the wisest and best thing 
that this government can do, both for its present and future 
welfare, for its perpetuity and growth among the nations, 
the most powerful, most beneficient and grandest of gov- 
ernments, would be to create a Bureau of Sanitation, not 
merely to keep out foreign epidemics of contagious diseases, 
but for psychical and physical sanitation of the many forms 
of diseases of the mind and body known to the science of 
modern medical progress, and recognize the profession of 
medicine as it does that of law, of agriculture and arms, by 
giving the most distinguished and capable of its votaries a 
proper and deserving place in the cabinet of the nation." 
In thus calling your attention to a subject which seems 
to me both proper and timely, I do not wish to be under- 
stood as considering myself called upon by you to advocate 
reforms, nor do I expect you to act upon any suggestions 
which I may have made, unless they appeal to your better 
judgment, for it must be confessed that they embody prob- 
lems that are not easy of solution. Yet we must remember 
that all forward movements are attended with opposition and 
I take it this will form no exception, as there are always 
men to be found in our profession who are ever ready to 
antagonize any step in advance, whether they understand 
the questions at issue or not, but facts are stubborn things 
and it takes but little insight to recognize the woeful indif- 
ference manifest by our profession in civic matters which 
are of a purely medical character, and it is the purpose of this 
paper to try and enlist your united interest and support m 
formulating some means or methods by which to overcome 
our seeming indifference and thus regain for ourselves the 
power and influence which properly belongs to our noble 
calling. 



jdbyGoOglc 



The Medtco-Legal Aspect of Eroto-Chorelc 
Insanities.* 



C. C. HERSMAN, M.D., Pittsburg, Pa. 

Ucturer on Mtntil ud Nervoui tXHiui. Wutan Pcnn. Unlwrdty {Msdlul DcpvtiHBl:) 

Member SUff Inunc Dapanmanl Si. Fraocls Hospital: Alienist South Side Hoi- 

pltihLateol W. Va. Hoipltal rorlnwn*^ Men»«r American. Pennsylvania Suie. 

AlleitiMy County and South PIttiburE Medical SoclaUe*; HoDonty Mnber 

W. Va. State Medical Society. 

CV. set. 13, school girl, over active mentally, has chorea, 
• third or fourth attacli, possibly a masturbator. A 
neighbor physician, who knows something of the family, 
states that he feels sure she is. Several cousins have had 
chorea and a number are strabismic. Some of the aunts 
have been nervous. There is an extensive history of con- 
sumption in the family. Patient attending school. On 

day of 189 — she went to the school house after school 

hours to get her books. The Principal of the school was 
at his usual evening work in his office. Pupil asked in- 
formation concerning some algebraic examples, which was 
given, after which she returned home. On the next morning 
before starting to school she told her mother that the Principal 
had thrown her down and ravished her. The father and 
mother, after careful examination, stated positively that 
they thought it not to be so, and dropped the matter after 
a statement by the Principal. In the meantime the little 
girl told some of her girl friends that she may have dreamed 
it all, that it might not have been so, all of which was testi- 
fied in court. Six months later disinterested parties in a dis- 
tant county through vindictiveness in another matter, had 
the Professor indicted for rape. He (the Professor) had 

■Readbelor* Ibe Stcilon on NeuroloEy and Medical Juriipiudence of the Anerl- 
can Medkal AstoclaiFon, at Philadelphia. June 2nd. 1897. 



jdbyGoOglC 



Eroio-Choreic Insanities. 415 

some enemies on the school board, although the majority 
testified in his behalf. In court the girl's evidence amount* 
ed to an assault only. She admitted that she had dreamed 
during the night that the Professor had assaulted her moth- 
er completing the object of his purpose. The Professor gave 
a clear, concise statement, unshaken by cross-examination. 
The judge in his charge to the jury stated that the Profes- 
sor had given a very clear statement, which had been un- 
shaken by cross-examination and that the pupil had failed 
by her own evidence, to sustain her charge, but added, 
"that if we always believed the defense we would never 
convict." The jury brought in a verdict of assault with 
intent to rape. 

Immediately following this 1 addressed these queries to 
a number of the leading Alienists and Neurologists: — 

1. Have you known a case of chorea insaniens to have 
gotten any one into the courts through charges of rape? 
If so, please give particulars. 

2. Have you known girls thus afHicted to.have been 
masturbators or nymphomaniacs? 

3. In the voluptuous dreams of such a patient could he 
or she have been so firmly' impressed by the dream that it 
would have been looked upon as a reality by the patient 
and so state under oath in court? 

4. Would a man run any risk of being criminally 
accused if he were associated with girls thus afflicted in 
places favorable to such accusations? 

The following replies were received: — 

I MR unable to Elve you any Information In answer to your questions 
concerning chorea insaniens. i have thought over the matter tor several 
days but hav« not been able to find anything that would help you.— F, X. 
DERCUM. 

1. Not personalty. 2. Very many Insanp girls are masturbators. 3 
and 4. Possibly.— H. C. WOOD. 

In the only case of chorea Insaniens that I have seen, there were no 
evidences of sexual disturbance. Answering your fourth question, I should 
think a man wruld run the risk of accusation under favorable circumstances 
by any sort of girls, choreic or otherwise. I should fancy, hWever, that 
courts would be very cautious about giving credence to the testimony of 
patients such as you refer to.— GEORGE H. ROHE. 



jdbyGoOglC 



416 C. C. Hersman. 

1. No. 2. No. 3. We cannot have positive knowledge on this point, 
as no one can know whetlier a persoo believes what he says he believes 
except the person himself. There seems to be strong evidence, however, that 
a sexuBi dream may be so vivid as to make the subject believe she has bad 
sexual congress. 4. A man would run a risk of being crirainallj' aiccnsed if 
he should associate with girls thus aOlicted (with nrDphomRnia) in places 
iwnuUe te sock aconatloiis.— CHARt^S W. BURR. 

In answer to your first and second questions I would say, no; to the 
third question, I would lay that among that class dreams are realities, and 
these people have vivid imaginations and they would be able to make any 
statement even under oath in court. Of course we must take what theysay 
with much "salt." in answer to your fourth question, I would say that the 
man rans every risk of being accused, and my advice to blm would be to 
give such patients a wide berth. Women should be the physicians to this 
class and not men, as slnply stated It Is this — the doctor places his repu- 
tation in the hands of a class whom the public are always ready to believe. 
—Martin w. Barr. 

t send you, in answer to your questions, a paper of mine on the general 
subject, in which on page 132 of the April number you will find references of 
service. If you will consult Spitzka on insanity you will find references 
covering your second question. Specifically I should answer to your first 
question, yes. In answer to your second query, I should reply that I 
believe this to be the case as a rule. In answertothe third, I would reply, 
yes, and a fact generally recognized by alienists. In answer to the rourth 
question, 1 would state, this danger has been recognized generally by most 
physicians who have practiced any lengtfi of time. You will find references 
bearing on your questions In the second volume of both McLane Hamilton's 
Jurisprudence and that of Wttthaus. The affirmative to your questions have 
so long been recognized as true by even jurists that I am astonished to see 
the questions raised.— JAS. G. KIErNAK. 

To the first I answer, no. 

To the second, i have known insane persons, male and female, to have 
been masturbators, and female Insane to have been nymphomanjacai. 

To the third, yes; i have known erotic dreams of the night to become 
the erotic delusions of the day and the patient oflerinE to be qualified before 
God and all the angels and insisting on prosecution of the wrong doer and 
protection from him. Such persons appeared sane enough to Impress their 
insane delusional convictions as truth on the non-expert and prima faeiai on 
the psychiatrical expert. If the patient's environments had been those of sane 
persons outside of a hospital for the insane. Such a person would undoubt- 
edly 50 state In court. 

To fourth, yes ; he would run the risk of being criminally assaulted If he 
were associated with a giri thus affected, that Is a rIfI greatly nympho* 
maniacal and of course insanely and irreslstably erotic under ordinary 
environments. I have had such an attempt made upon myself In a hospital 
for the insane and never after went Into the private presence of the patient 



jdbyGoOglC 



ErotO'Choreic Insanities. 417 

or of such patients, that Is In Hwtr rooms, wfthont being accompanied by an 
elderly matron or war] attendant In order not to arouse the erotic morbid 
Impulse. 

He might on another time, if a morbid aversion should seliesucb a per- 
son tor having had her approaches and caresses unreciprocated or from other 
ot the many Imaginary causes peculiar to the Insane, be liable to false and 
criminal accusations of the patient. 

Sometimes "Hell hath no fury like a woman scorned" under such cir- 
cumstances, especially if the woman be nympbomanlacalty Insane at the 
time. The odi it amo alternates In these persons as in the sane, thouKh In 
a more Intensified and less regulated degree. Any man who has to do with 
nymphomaniacs runs the risk ol unfounded crfmiusl accusations, especially 
medical officers ot asylums for the Insane. They run especial risks of being 
ruined by them In reputation In the esteem of those who do not understand 
them, and the wisest plan Is always to meet such pAtlents with a chaperon. 
Their dreams do not always "presage (oyful news at hand" for the helpless 
superintendent who meets them without vindicating witnesses. — C. H. 
Hughes. 

On the subject of Chorea Insaniens, I quote, "Chorea 
Insaniens occurs at or soon after puberty, or as the result of 
pregnancy. In rhilder cases there are merely delusions of a 
slight form, and the patient has extreme loquaciousness," 
etc.* Berkeley records a. case in which, among other things, 
he found under the surface of the clitoris "an elevated and 
excoriated non*indurated sore." [Possibly a masturbator.] 

Clouston says that "early youth is the common time 
for chorea." Cowers says that "it occurs chiefly in fe- 
males at or soon after puberty, or during pregnancy." 
Again, "mental disturbances are rarely absent in chorea. 
Insanity develops more frequently during chorea than is us- 
ually supposed."! Also Putzel reports several cases of 
masturbation among female choreics; "if masturbalors, they 
may have been nympho -maniacs as well." (Italics mine). The 
subject of this report was at or near the independent natural 
growth of the reproductive organs; near the time of reflex 
action upon the mind of these bodily changes, an inherent 
quality of immaturity. Just at the time the new desires, 
sentiments and passions are awakened by th** development 
of these new functions. The motions and passions at this 
time are also in great force; the time when the Judgment 

■WlMTton Sinkiir. Dercun'i Nirvoui DIkimi by Ameiicin Aulhori. 



,db,GoogIc 



418 C. C, Hersman. 

is only taking; a time when the controlling influence was 
weak; a climacteric that completely overshadows the meno- 
pause. In looking up the delusions of choreic insanity, I 
find mentioned by Putzel, McLane Hamilton and others, a 
number of cases. These cases were mostly girls. A delu- 
sion almost always present, that men were around. In one 
exception only, those exhibiting the delusion were girls. 

Take these cases plus nymphomania and we have a 
very dangerous combination. 1 have known nymphomaniacs 
to assault men on a number of occasions. One in particu- 
lar I refer to, assaulted at one time one of the medical offi- 
cers of the institution, at another, the Superintendent and 
finally, the writer. These assaults were all within the 
building and due to her highly sexually excited condition. 
Again I have known nymphomaniacs to interpret dreams 
(or nocturnal delusions) as realities. A young lady believed 
that one of the medical officers of the institution visited her 
nightly and had to do with her. His mode of access was 
to come up the hot air flue and enter through the register. 
Hence, if a dream (for dream it must have been) can im- 
press the unbalanced mind so firmly, may it not have been 
that this little girl might have had some such delusion? 
Owing to the fact that she said nothing until the next 
morning, that she confessed to the court that she had 
dreamed during the night that the Professor had assaulted 
her mother and that she told a number of her schoolmates 
that it might have been a dream — all this from a neurotic, 
choreic, mentally over-active child — to say the least, we 
should take It cum grano satis. 

The author on the witness stand averred that such 
may have been the case (and from a full account of the 
case, and a history of the patient, past and present, of the 
family and relatives by the family physician, he has faith 
in the statement), but the opinion was ruled out as irrele- 
vant. 



jdbyGoOglc 



SELECTIONS. 



NEUROTHERAPY. 



HYOSCYAHINE FOR PARALYSIS AGITANS.— The expe- 
rience of Dr. Chalmere, of Chicago, as given in the New York 
Medical Journal, is tliat every one of these well-marked 
cases is a sufficient warrant for a test of hyoscyamine in 
similar cases. The first case was that of a clergyman 
where the shaking of the head and the right upper and 
lower extremity had been on the increase for four years. 

A drop of solution of hydrobromate of hyoscyamine, two 
grains to the ounce, was put into the eye. In twenty 
minutes the shaking had entirely ceased and at the end of 
three quarters of an hour speech was difficult and the pa- 
tient was unable to rise from his chair. This partial pa- 
ralysis gradually disappeared, there being no return of the 
shaking for several hours. In this case as in the other, 
the use of a solution of one grain to the ounce was suffi- 
cient, applied at stated times to keep the patient entirely 
comfortable. Even a temporary relief obtained without in- 
jury to the system will be hailed with gratitude. 

IN WHAT CASES OF INSANITY IS THYROID EXTRACT 
USEFUL?— Dr. C. L. Dana (Can. Prac.) reported at a 
meeting of the Practitioners' Society, New York, a case of 
insanity cured by the thyroid extract. The patient, a 
young lady, unmarried, aged 28 years, with no especial 
neuropathic taint in the ancestry. One older brother had 
Basedow's disease, from the age of 35 to 39, when he was 
cured and remained so. One younger sister had hystero- 
epilepsy; a second brother is of a nervous temperament, 
and suffers from insomnia; and another sister had attacks 
.of migraine. The duration of her mental trouble, which 
commenced with a mild form of confusional insanity, was 

L419] 



jdbyGoOglc 



420 Selections. 

two years. On account of the steadily progressive charac- 
ter of the trouble and the apparent evidence of serious 
degenerative changes coming on in the brain the question 
finally arose whether an operation for the removal of the 
ovaries should not be attempted as an experiment, although 
the pelvic organs had been carefully examined and found 
perfectly normal. 

Dr. Dana advised that before attempting any such op- 
eration the patient be placed upon the thyroid extract and 
to push the drug to the point of tolerance. She had been 
previously treated with the thyroid extract but without any 
results. Treatment was commenced by administering five- 
grain thyroid tablets beginning with IS grains a day and 
gradually increasing the dose until she was taking60 grains 
a day. At the end of two weeks, symptoms of improve- 
ment appeared, and at the end of three months she had 
become thoroughly sane. She talks intelligently and co- 
herently, has no delusion, and writes a sensible, well word- 
ed letter. 

The improvement has been so striking and progressive 
and so definitely associated with the use of the thyroid, 
that there can be no doubt as to its being the cause of the 
change. The fact that a brother suffered from Basedow's 
disease in a very typical way is a curious illustration of 
what might be called a thyropathic tendency in the family. 
He thought the cases of insanity in which the thyroid ex- 
tract proved beneficial probably were cases in which there 
were some derangement of the thyroid gland. 

In the discussion which followed. Dr. F. P. Kinnicutt 
said he believed the treatment of insanity with thyroid ex- 
tract had not been very encouraging, and therefore, the 
case reported was the more interesting. He thought the 
very fact that in a large majority of cases the treatment 
was without effect, while now and then it was so strikingly 
successful, would indicate that in the latter the trouble was 
probably connected with diminished or perverted secretion 
or function of the thyroid gland. It was known that there 
might be interference with the function of the gland .and 
that structural change might even exist without any ana- 



jdbyGoOglC 



Selections. 421 

tomical signs being detected during life. He repeated that 
it seemed fair to assume that in the cases of insanity in 
which the extract was of benefit there was destruction or 
perversion of function in the thyroid gland. 



PSYCHIATRY. 

THE CASE OF SPURGEON YOUNG— DEATH DUE TO 
HYPNOTISM BY UNSKILLED AMATEURS.— An important ques- 
tion, alil{e of medicine and of law, in other words, a question 
in the interesting field of medical jurisprudence, arose and 
received elaborate consideration in the recent autopsy over 
the body of Spurgeon Young, before the coroner and jury 
of Chautauqua County, N. Y. The deceased was a colored 
lad, seventeen years of age, and the scope of the inquiry 
touching his death, was "how far it was due to or trace- 
able to his condition, as affected by the repeated placing of 
the lad in a hypnotic state, by hypnotizers who are not 
skilled in the matter, and in which, it was thought, that 
he sustained physical injuries which might have incited the 
disease of which he died." The expert medical opinions 
submitted and the conclusions reached are embodied in a 
paper read before the Medico-Legal Society of New York, 
on February 20, 1897, by the Hon. Clark Bell, vice-chair- 
man and secretary of the Psychological Section of said 
society. 

The inquiry as to the physical or pathological effects of 
such hypnotism took the form of a hypothetical question 
submitted in writing by the coroner to a number of the 
leading medical jurists of the country. This hypothetical 
question, which is lengthy, stripped of much of its detail of 
diagnosis, was whether, "in a case of a youth, seventeen 
years of age, who had for approximately six months been 
a chronic 'sensitive subject,' having been protractedly and 
repeatedly hypnotized many times by amateurs and irre- 
sponsible and reckless youthful dabblers in hypnotism, — 
would physical injury or organic impairment, directly or 
indirectly, follow from the psychic or emotional disturbances 



jdbyGoOglC 



422 Selections. 

or derangement of nerve function, involved in or due to, 
the morbid innervation incident to sucli hypnotic practice, or 
experimentation in 'mesmerism' or alleged animal magne- 
tism?" 

With one exception, the unanimous voice of the scien- 
tists was that such experimentation and hypnotizing is 
vicious and dangerous. This consensus of expert opinion 
may be summed up as expressed by the Hon. Thomson Jay 
Hudson, LL.D., of Washington, the learned author of "The 
Law of Psychic Phenomena," who is regarded as a high 
authority in the whole domain of "hypnotic suggestion," 
In his exhaustive reply he sums up by saying, "In my 
opinion, there could be but one inevitable result, namely, a 
shattered nervous organism, leading eventually, if life is 
prolonged, to imbecility or insanity." He further says, "I 
have been led to believe that there are few bodily diseases 
that may not be produced by abnormal, mental and nervous 
conditions. 'Who will pretend to assert that any tissue of 
the body is beyond the range of nervous influence?' " 
Says Prof, W, Xavier Sudduth, that such hypnotic sugges- 
tion is "fraught with grave dangers. * * * Those who 
practice them should be held criminally liable." The dis- 
tinguished alienist of St. Louis, Dr. Charles H. Hughes, 
whose repute is world-wide, declares that: "The repeatedly 
hypnotized subject becomes a more or less changed man as 
compared with his normal state, and to this extent, is in 
an insane state of mind with this difference from the ordi- 
narily insane person, that his change of mental character is 
chiefly subject to the directing influence of another person 
rather than to his own perverted and abnormal volition, as 
is the case with the ordinary insane person. But he may 
become as insane and diseased in brain as an ordinary 
lunatic." And so say with one accord the whole venire of 
medico -jurists. 

They were of opinion, as expressed by Dr. Buck, that 
"the practice is harmful under all circumstances except in 
the hands of skillful physicians for the treatment of disease, 
and even then in a narrow range of diseases and with 
doubtful results. In all other cases it is dangerous, and 



jdbyGoOglC 



Selections. 423 

should be suppressed bylaw and with severe penalties." And 
so the coroner's jury returned, concludiug their verdict: 
"We would recommend that the state legislature pass a law 
prohibiting the practice of hypnotism." 

There exist in St. Louis empirics who advertise "Hyp- 
notism taught in * * * lessons;" these constitute a 
public danger and should be subjected to the police power. 
— Joseph Wheless in American Law Review. 

SYPHILITIC MELANCHOLIA.— Dr. B. E. Spitzka, of 
New York, in a paper read before the New York Academy 
of Medicine discussed (University Med. Jour.) the diagnosis 
between genuine melancholia and a somewhat similar con- 
dition observed in the initial period of syphilitic dementia. 
The true melancholiac was sad because he could not be 
anything else; the other was depressed because he was 
unable to attend to his business and suspected that his 
friends realized this. The former suffered from insomnia 
while the melancholiac of the initial period of syphilitic de- 
mentia slept perfectly through the night and often also 
through the day. The true melancholiac was universally 
neglectful of his dress? The other was very particular about 
certain parts of his dress and negligent about other portions. 
The true melancholiac shrank from company, the syphilitic 
melancholiac was irritable and his symptoms varied greatly 
from day to day. The syphilitic finally drifted into a con- 
dition in which slight but characteristic changes in the 
medulla oblongata were found. The diagnosis was impor- 
ant because proper treatment in the early stage might 
prove radically remediable. In his experience the common 
error had been that of too exclusive reliance on the iodides. 
His own initial treatment was always with mercury, pref- 
erably by inunction. These patients- were usnally over 45 
years of age, and suffered from renal insufficiency. 

F. R. Sturgis, of New York, thought that these pa- 
tients often threatened suicide, but seldom attempted it, for 
in syphilitics the power of coming to a decision was lost. 
Their melancholia developed apparently from totally inade- 
quate causes, and they often exhibited sudden alternations 



jdbyGoOglC 



424 Selections. 

from extreme depression to a more natural temper. Un- 
questionably, mercury was the mainstay in these cases, 
but the iodide played an important part, because its action 
was very much more rapid than that of mercury; it would 
often hold in check the more serious subsequent symptoms, 
and the rapid improvement that it caused in the symptoms 
often settled the diagnosis. The time and the doses of an 
iodide were the most important points in the successful 
treatment of nervous syphilis. From 300 to 600 grains of 
potassium iodide in the twenty-four hours would make all the 
difference between failure and cure. 

L. D. Bulliley indorsed the views of Dr. Spitzka to the 
value of a certain amount of mercury with the iodide of 
potassium. It accomplished the same result with a greatly 
diminished dose of iodide. It was his custom to prescribe 
inunctions, or one or two mercurial baths a week, along 
with the use of the iodide internally. Williams said that, 
if in these cases of melancholia the temperature remained 
subnormal the greater part of the time for several succes- 
sive days, practitioners were justified in suspecting late 
syphilis. Absolute rest in bed from three to six days was 
important, and during this time it would be found that the 
temperature would gradually rise. D. F. Sherman also in* 
dorsed the view that it was important to use mercury in 
liberal doses, along with the iodide, Spitzka had intended 
to state that these syphilitics often contemplated suicide, 
but only actually committed it on the impulse, and without 
premeditation. Although gastric irritation was quickly pro- 
duced in ordinary persons by large doses of iodide, in the 
cases under discussion very large quantities of the iodide 
not only were tolerated, but often seemed to act like a 
charm. 

COMMITTEE ON DISEASES OF THE MIND AND NER- 
VOUS DISEASES.— A. W. Hoisholt, of Stockton, chairman of 
tile committee, read a report entitled, "Some Statistical 
Observations on the Subject of the Etiology and Symptom- 
atology of Dementia Paralytica." After giving a few facts 
connected with the history of the disease from its first notice 



jdbyGoOglC 



Selections. 425 

by Willis, in 1672, to the publication of Prof. Mendel's 
monograph, "Die Progressive Paralyse der Irren," in 1880, 
and stating the modern views as to the pathological anatomy 
of general paralysis, the author gave the results of his study 
of 69 male paralytics, who had been inmates of the Stock- 
ton asylum between April 1, 1890, and April 1, 1897. Of these, 
50 had died, 19 were still inmates. During the first five 
years, 42 had been received, of whom 2 only were still liv- 
ing. Of the remaining 27 cases, 10 had died. The average 
percentage of paralytics to all cases (1,342) of insanity 
admitted (excluding readmissions) was 5,13 per cent., which 
is low compared with the reports from European asylums, 
and is probably due to the difference in the character of the 
cases admitted, which in the Stockton asylum would tend 
to increase the number of admissions without adding cor- 
respondingly to the number of general paralytics. The pro- 
portion of female to male paralytics in the state asylum 
w,as 1.35 per cent, to 5.13 per cent., or 1 to 3,8, which 
corroborates reports from most asylums. As regards nativ- 
ity, 33 were Americans, 36 foreigners; of the latter, 1 was 
Chinese, a percentage of 1.09 of the total first admissions 
of Chinese (91), which would seem to show that general 
paralysis is much more frequent among white people than 
among Chinese. Of the 69 paralytics, 6 were convicts, 
while only 36 convicts were admitted during the same 
period, which would give a percentage of paralytics 3.45 
times greater than that found among paralytics who were 
not convicts. 56.25. per cent, of the 69 cases occurred in 
individuals between the ages of 35 and 44, the age of the 
greatest bodily and mental development. On the subject of 
etiology the author gives a resume of the modern ideas as 
to the relation of syphilis to general paralysis, regretting 
that the information on this point obtainable in this and 
other states of the Union was of but little value. There 
was a history of syphilis in his cases in 37.68 per cent. 
He found heredity present in 10.14 per cent,, while in 
insanity in general there is a history of heredity in one- 
third of the cases. Trauma was mentioned as an occasional 
cause and a case was given in illustration. There was a 



jdbyGoogle 



426 Selections. 

history of a prior attack of insanity in 2 of the 69 cases, 
which, however, might have been instances of remission of 
the disease. The average duration of asylum treatment in 
the 50 deceased cases was 16,74 months, which is almost 
exactly the same as that reported from asylums at Berlin 
and Hamburg in 1494 cases. This would seem to show that 
climatic influences and treatment have but little effect upon 
the course of the disease. He had examined into the ques- 
tion of the presence of ulnar analgesia in general paralytics, 
and the results of his investigation corroborate those of 
Cramer, Hess, GObel, and others. He found unilateral or 
bilateral analgesia present in 85.7 per cent, of 21 paralytics, 
in 38 per cent, of 21 epileptics, and 23.8 per cent, of 21 
other cases of insanity. The author then took up the men- 
tal symptoms met with in general paralysis, dwelling par- 
ticularly upon hallucinations and attacks of fear, giving a 
clinical history of two cases in illustration. In conclusion, 
he spoke of the importance of the difterent diagnosis of 
dementia paralytica in its early stage, especially from cere- 
bral neurasthenia. — Proceedings California Slate Medical 
Society. 



CLINICAL NEUROLOGY. 

NEURASTHENIA,— H. N. Rucker, of Oakland, read a 
paper upon this subject, which he said would deal with the 
special features of this ailment. Neurasthenia in early life, 
that is, in school children, is more sudden in its onset and 
more transient than in adult life. It is an almost unfailing 
indication of inherited nervous instability. Such children are 
active, ambitious, precocious, without the physical stamina 
to enable them to compete with their fellows. After the 
inevitable break down, if the medical attendant appreciates 
the situation, he does the best possible thing by advising 
that the child shall be kept from school for an extended 
period and provided with wholesome exercise. The speaker 
believed that cases of this character, especially in girls, had, 
heretofore, not been well understood. Another, and far 
larger class of neurastheni(?s are to be found in both sexes 



jdbyGoOglC 



Selections. 427 

between the ages of 20 and 40 years. The struggle for life 
during this period was at its height, hence there is a greater 
tax upon the nerve forces. Undue application or mental 
overwork, under improper conditions, will usually show their 
effect sooner or later in those having a predisposition to 
nervous instability. Rest and change from the ordinary 
habits of life will, as a rule, succeed in restoring man's 
lessened vitality. With females the result is more uncer- 
tain, as many of the consequences of nervous exhaustion 
tend to become permanent. Efforts made for the relief Of 
such patients have given rise to many abuses in abdominal 
surgery. A third class of neurasthenics may be found in 
those who have passed the meridan of life, and have gone 
beyond the border line of final recovery, who, weighted 
with responsibilities too heavy to bear, then become pre- 
maturely old. Despondency ending in suicide is sometimes 
the result of this condition. In conclusion, the speaker said, 
neurasthenia, like hysteria, is an ailment of the protean 
type, and there is scarcely a disease which it does not, in 
some respect, resemble. In the treatment, rest is the all 
important factor, coupled with recreation in a moderate 
degree. 

Dr. A, W. Hoisholt, of Stockton: I have listened with 
great interest to the paper of Dr. Rucker, 'and I think the 
subject is one that cannot be brought to the attention of 
the profession and of the public often enough. The hygiene, 
which the doctor briefly referred to, is of the greatest 
importance, and as the disease of neurasthenia has been termed 
the disease of the age, which it is, and as it is becoming 
more and more frequent, the proper understanding of it is 
important. I have seen cases in children which began as 
neurasthenia. The child was overtaxed at school, and, 
having great ambition, was unable to accomplish what it 
desired. The result was that doubt arose in its mind; this 
doubt became morbid, and finally the child doubted its ability 
to do anything, and became apprehensive of almost every- 
thing. Such cases become juvenile insanity. In this con- 
nection, I will again refer to what 1 said in my paper a 
short time ago, that you have in general paralysis in the 



jdbyGoOglC 



428 Selections. 

early stage what has been called the neurasthenic stage of 
general paralysis, in which you can have all the symptoms 
that the author has enumerated. The treatment that has 
been instituted very recently, namely, the anti -syphilitic 
treatment, in the early stage of general paralysis, has by 
some late investigators been found to have marked results 
on the course of the disease — they report cures. If that be 
the case, the important thing is to recognize that disease 
early, and to bear it in mind in coming across cases of 
neurasthenia. — Proceedings California State Medical Society. 

INCREASE OF INSANITY AND CONSUMPTION AMONG 
THE NEGRO POPULATION OF THE SOUTH SINCE THE 

War — Abstract of a paper read by Thomas J. Mays, A. M. 
M. D, before the Section of Neurology and Medical 
Jurisprudence of the American Medical Association, June 
3, 1S97. 

The Cincinnati Lancet Clinic gives the following very 
satisfactory abstract of this interesting statistical paper: 

Statistics gathered from the superintendents of Southern 
hospitals for the insane show that both insanity and_ pul- 
monary consumption increased disproportionately among the 
negroes of that section of our country since the close of the 
civil war. Thus, according to the United States Census, 
there were in 1860 only 44 insane negroes in the State of 
Georgia; in 1870, there were 129; in 18S0, 411 ; and in 1890, 
810. In North Carolina there were in IS80, 91 colored in- 
sane; in 1885, 144; in 1890, 244; in 1895, 307; and in 1896, 
270. In Virginia before 1865 there were about 60 insane 
negroes in the asylums of that state, and now there are over 
1,000. In the Eastern Hospital for the Colored Insane in 
North parolina, consumption caused 14 per cent, of the 
total number of deaths in 1884, while in 1895 it produced 
27 per cent, of all the deaths, and this in spite of a re- 
duced general mortality- rate. In the Mississippi Lunatic 
Asylum, from 1892 to 1896, consumption caused 42 per 
cent, of the total number of deaths among the negroes, or 
an increase of 22 per cent, over the death-rate from this 
disease among the white population outside of hospitals for 



jdbyGoOglC 



Selections. 429 

the insane (it, of course, being well known that insanity 
predisposes to phthisis), if the latter is estimated at 20 per 
cent. In the Alabama Insane Hospital during three years 
and nine months beginning October 1, 1890, there occurred 
295 deaths among 1,700 white and negro patients. Of the 
179 deaths among the white patients, 28 per cent, were 
due to tuberculosis, and of the 1 16 deaths among the 
negroes 42 per cent, were due to the same disease. 

From this and other evidence which is presented it is 
concluded that both of these diseases have disproportion- 
ately increased since the war, and that in all probability 
the causes which led to one also led to the other disease. 
The writer holds that the cause of phthisis resides in a 
disintegrated nervous system, and cites a number of con- 
current authorities, as well as clinical and pathological data, 
to prove his position; and, among other conclusions, he 
draws the following: That both consumption and insanity 
are closely allied, both in personal and family history, to 
idiocy, hysteria, epilepsy, asthma, and other diseases of the 
brain and spinal cord; and that they are both produced by 
syphilis, alcohol, overwork, business vicissitudes, domestic 
appointment, and excesses of all sorts — in fact, by any 
agent or influence which vitiates the brain or nervous sys- 
tem; and that those who are confronted by a new and 
higher civilization, and who are compelled to adjust them- 
selves to these new relations, are excessively liable to fall 
victims to insanity and pulmonary phthisis. 

The condition of the negro is Viewed from these prem- 
ises. Civilization is regarded as an accumulation of force, 
and the older the civilization, the greater its momentum 
and the higher its plane; and when a lower civilization is 
precipitated in the midst of a higher, like in the case of 
the negro, it is the throwing together of two forces which 
differ in power and rate of motion. The lower, in order 
to preserve itself, must make an effort to adjust itself to 
the course and changes of the higher movement, and the 
strain which is occasioned by this effort of adaptation falls 
on and vitiates the brain and nervous system, and this in 
turn gives rise to insanity and phthisis. The vices of 



jdbyGoOglC 



430 Selections. 

alcoholism and syphilis, which are readily acquired by these 
people, accelerate the advent of these diseases by destroy- 
ing the integrity of the brain and nervous systfn. 

Viewing the condition of the Southern negro from these 
standpoints, it is perfectly obvious why insanity should nec- 
essarily develop, and on no other grounds can we explain 
why consumption should follow in the wake of insanity. 
Those who were able to realize all the factors which would 
be called into activity by the environmental changes of the 
negro after the war could, at the time it was made, have 
foretold the inevitable results which are now but too plain 
to. every one. It is in part a repetition of what happened, 
and now happens to the aborigines of North America, Aus- 
tralia, and New Zealand, who in their unequal warfare 
with modern civilization have been and are being fast dec- 
imated and exterminated by pulmonary phthisis. 

EMOTION DYSPEPSIA.— According to Dr. O. Rosbacht 
Emotion Dyspepsia presents (S^r/iM. KHn. IVoch.) the follow- 
ing features: Immediately or a few days after a fright or ve- 
hement emotion, besides nervous manifestations and mus- 
cular pain in the back and abdomen, there set in mild and 
severe symptoms of indigestion, aversion to food; either 
dryness in the mouth or excessive secretion of the saliva; 
pressure in the epigastric and hypochondriac regions; sen- 
sations of swelling and at times visible prominence of the 
epigastrium, dyspepsia, belching, flatulence sometimes colic 
with irregular diarrhcea. The patients feel hungry but find 
no flavor in the food. As a rule they are very cautious in 
selecting their food after abstaining from It entirely; but 
this is instrumental in aggravating the hyperesthesia of the 
digestive organs. Voracious appetite alternates with com- 
plete loss, diarrhoea with constipation, heart burn with 
eructations of gas, and finally, the patient reaches an almost 
cachectic state. Vehement emotion occurring when the 
stomach is full is less injurious than when it is empty; 
while the consumption of a meal during emotion often gives 
rise to the disease in question. This affection may be 
diagnosed by considering the aetiology, the changeableness 
of symptoms, the normal gastric contents and absence of 



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objective symptoms in contrast to the complexity of the 
complaint of the patients and with their nervous temper- 
ament. 

Birth-Palsy.— Dr. D. McDonnell defines this (Brit- 
ish Medical Journal, Feb. 20, 1887) condition as paralysis 
caused by events taking place during or prior to delivery. 
The proximate cause was usually cerebral hemorrhage and 
the chief predisposing causes were: (1) The delicate struc- 
ture of the blood-vessels in the infantile brain; (2) hyper- 
venous conditions of the blood; and (3) diseases of the 
vascular walls, especially syphilis. The principal exciting 
causes were trauma of the mother during gestation and 
prolonged or difficult labor. The symptoms were arrested 
mental development, various forms of paralysis {hemiplegia, 
paraplegia, diplegia spastica, etc.,) and morbid movements 
such as choreiform, athetoid, associated and polymyoclonic. 

NEURASTHENIA AND GENERAL NEUTRITION.— Dr. J. 
T. Edes, of Jamaica Plains, Mass., states in a paper read 
before the American Physicians* Association (Journal of the 
American Medical Association, May 22, 1897) that gain in body 
weight and improvement in neurasthenic symptoms usually 
go together, but there are enough exceptions to the rule to 
show that the nervous nutrition is something more than a 
mere sample of the general. The more symptoms approach 
in character the "fixed ideas" of the insane the less amen- 
able are they to the beneficial effect of mere somatic thera- 
peutics. The blood color of a considerable number of neu- 
rasthenic patients corresponded quite closely with that of 
the employes in the same institution. It was not possible 
to establish any correspondence between the degrees of 
anaemia and the intensity of nervous symptoms. Measure- 
ments of the excretion of uric acid afford no sufficient ground 
for supposing that neurasthenic symptoms depend in any 
way upon this substance. There may be such a thing as a 
chronic uric acid headache, but the ordinary continued neu- 
rasthenic headache is not of this character, Indican deter- 
minations have not been numerous enough to be decisive ' 
but do not seem to indicate that the poison consists in this 



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432 Selections. 

substance or in those which may be transformed into it. 
If neurasthenia is a toxic condition, the poison has not yet 
been satisfactorily identified. Dr. James J. Putnam remarked 
that neurasthenic patients often looked pale and bloodless 
when they would have a normal amount of blood and hem- 
oglobin. Haig's writings were attractive but they were 
devoid of that critical spirit which one would look for in 
dealing with such an important subject; there were loop- 
holes for error in every step of his theory. Changes in 
metabolism are affected by the nervous system and normal 
and pathologic activities are immediately connected with 
changes in metabolism. When two subjects are so. closely 
connected it is difficult to say which is the cause or which 
is the effect or if it is merely a coincidence. 

CONSTIPATION IN THE INSANE.— Alessi {Journal oj the 
American Medical Association, May 15, 1897) finds that 
mental troubles are aggravated when there is constipation 
and improved when the functions are regular. He also finds 
that in the melancholic forms of insanity, the intestinal 
atony preceded the outbreak of the insanity, while in vio- 
lent mania it follows and seems to be produced by it, as 
there is evidently some connection between the action of 
the intestines and the degree of excitability of the cerebro- 
spinal nerve centers. He concludes an interesting study of 
90 cases with an account of a woman brought to the clinic 
in violent mania which had developed suddenly that day. 
Inquiry of her mother elicited the fact that she had not 
had an evacuation for fifteen days, and the administration 
of 80 centigrams of calomel and 60 of scammony restored 
lier promptly to sanity, as the intoxication had not lasted 
long enough to impair the integrity of the nerve cells. 

UNTOWARD EFFECTS OF TRIONAL.— Dr. K. B. Her- 
man, of Memphis, Tenn,, states {Journal of the American 
Medical Association, June 5, 1897) that a patient of his 
took a dose of 20 grains of trional at 10 P. M. for insom- 
nia with the following peculiar results: Shortly after hav- 
ing taken it he went to sleep and did not awaken until he 
was aroused the next morning for breakfast. Not feeling 



jdbyC'OOglC 



Selections. 433 

very well, he had a cup of coffee brought to his bed. 
After a short while he arose and went to his office but 
feeling very bad he returned home about 10:30 A. M. and 
again lay down and went to sleep. On being aroused for 
dinner by the servant, his wife being away, he responded 
that he would be down in a few minutes, but instead he 
went to his club for dinner. While at the club he must 
have felt ill as he went into the lounging room and slept 
until 7:30 when he was awakened by a porter. He felt 
completely dazed and as if he had awakened from a hor- 
rible dream. It was some time before he could collect him- 
self and realize that he was at the club. . He was very 
much surprised to find himself there, as he had absolutely 
no recollection of having gone there, or eaten dinner or 
slept therfe. His mind was a blank from the time he 
returned from his office in the morning at 10:30 A. M. until 
7:30 P. M., having remembered nothing he had done during 
that time and reporting this effect from hearsay. During 
this time he met several friends who say he talked and 
acted rationally but complained of a severe headache. 



NEUROPATHOLOGY. 

EPILEPSY— AUTOPSY.— Hiss E. V., September 10, 1892, 
had her first attack. In March, 1892, she had grown worse. 
Her mind was more sluggish; it was difficult to carry on a 
conversation with her. Her emotional system was excited 
and uncontrollable ; why, she did not know, was af- 
flicted with insomnia, staggering gait, would trip easily, but 
recover herself, would grasp her head with her hands and 
say it felt so funny. Her enunciation was imperfect, and 
the laryngeal sounds were hoarse and husky, as though 
the cords were swelled or lacked tension. Patella reflex 
was exaggerated. Sensation good everywhere. She soon 
got so that she could not walk without assistance. She 
had become apathetic. When asked a question she could 
not answer intelligently. She would sit and look into va- 
cancy, with a dazed, worried look and while t>eing talked to 



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434 Selections. 

would fall asleep, articulation hardly intelligible, deglutition 
difficult, and she would frequently strangle. She had a ten- 
dency to put one or both hands on her head, and when 
removed she would put them back again. 

Until April 2 she was able to sit up, and could be 
helped from bed to a seat. She was unable to articulate, 
and finally could not swallow anything, became insensible 
and helpless, and so remained until she died April 5, 1896. 
She at no time had fever, and her pulse was normal. 

On post mortem examination a large amount of fluid 
escaped from the longitudinal fissure. The membranes and 
external surface of the brain appeared perfectly normal. A 
careful inspection of the base of the brain showed no ab- 
normality that could be detected. Every part of the cere- 
brum, cerebellum, pons and medulla was carefully unfolded 
but nothing could be found abnormal except distended 
lateral ventricles. The distension of the ventricles was so 
great that the anterior and posterior cornui were entirely 
obliterated. The choroid plexus was thickened and congest- 
ed. The tension of the fluid in the ventricles was so great 
that it ruptured into the longitudinal sinus when the brain 
was removed. — Dr. J. L. Cleveland in Cincimiaii Lancet, Clin- 
ical Report to Cincinnati Academy of Medicine, 

THE PATHOLOGY OF APHASIA.— In the Lumleian Lec- 
tures Dr. Bastian has discussed at length a subject which 
has occupied his attention for many years, and to which he 
has shown himself to be capable of doing equal justice as 
a clinician and a psychologist. The light thrown upon the 
localization of cerebral lesions by the study of their asso- 
ciated speech defects is very great, whatever may be our 
opinion as to the correctness of the theoretical conclusions 
arrived at by investigators. To form an adequate apprecia- 
tion of the arguments of the Lumleian Lectures, and par- 
ticularly of the parts in which the ordinary designations of 
motor and sensory aphasia are attacked, it is necessary to 
bear in mind the nature of the controversies which have 
arisen among those who have given the subject their par- 
ticular attention. Thus in one important theory Dr. Bas- 



ket byCoOglc 



Selections. 435 

tian differs widely from the majority of present day neu- 
rologists and physiologists. He has from tlie first persist- 
ently maintained that the so-called motor area in the cere- 
bral cortex is really sensory in function, being employed for 
the purpose of inducing and inciting action in what he re- 
gards as the true motor centres, which he locates in the 
grey matter of the bulb and cord. These bulbar and spinal 
centres are, according to the common view, subsidiary in 
function, acting under the direction of the motor cortex. It 
would be impossible here to enter into a discussion of this 
difficult but essential question, but it may be observed that 
whereas Dr. Bastian was for something like twenty years 
practically alone in attributing sensory properties to the 
"motor cortex" the recent researches of Dr. Mott have 
conclusively affirmed his views, and the area is now gen- 
erally admitted to be "sensori- motor." Whether his 
refusal to allow that this region possesses any motor func- 
tions will be substantiated by future observers may, how- 
ever, considering the trend of recent researches, be regarded 
as doubtful. 

Coming to the particular question of aphasia Dr. Bas- 
tian postulates the existence of four centres in the cerebral 
cortex which are concerned in the production of spoken and 
written language. Two of these, in the posterior parts of 
the cerebrum, correspond in position to the visual and (as 
far as is known) auditory centres, and are of the' ordinary 
sensory type; the others, in the second and third frontal 
convolutions respectively, he regards as the excitomotor (or 
as he prefers to call them, kinesthetic) centres for writing 
and speech'. For various reasons, many of which yet 
remain to be investigated, the left half of the cortex has, 
in right-handed people, become dominant for purposes of 
speech. The most interesting cases therefore cluster round 
lesions of the left hemisphere, but Dr. Bastian shows well 
how, under special circumstances, the centres on the right 
side come to the assistance of their damaged colleagues. 
Another important point to which he directs attention is the 
system of commissures between the various centres, the 
value of which is exemplified by such actions as reading 



jdbyGoOglC 



436 Selections. 

aloud and writing from dictation. Here, again, it is shown 
that when any particular channel is blocl<ed, other com- 
missures may tal<e on the work. This is true in particular 
of the callosai fibres connecting the two hemispheres, and 
here it is interesting to note how completely the experi- 
mental results of Prof. Sherrington tally with the clinical 
deductions of Dr. Bastian. We are now constrained to ad- 
mit that there exist in the corpus callosum oblique fibres 
joining the third left frftntal convolution with the upper 
part of the right tempero-sphenoidal lobe. 

The theory, then, which Dr. Bastian upholds is that 
aphasia depends either upon damage to one or other of the 
four centres in the dominant hemisphere, or upon interrup- 
tion of the commissures connecting them. It may, however, 
happen under favorable conditions that the centres of the 
subsidiary hemisphere may serve as substitutes for those 
whose functions are impaired, and that this replacement 
may be aided by the opening up of new paths of connec- 
tion between centres hitherto unassociated. The substan- 
tiation of this view must necessarily be purely clinical, and 
to this end the cases collected by Dr. Bastian are of ex- 
treme value. 

His work, however, has been not only constructive and 
speculative; it has also been destructive and critical. One 
of the most important sections of the lectures is that in 
which he shows that the term "sensory aphasia" is' a 
cloak loosely thrown over a multitude of conditions, each 
one of which he proceeds to pick out and subject to sepa- 
rate analysis. Nor is he less conclusive in his demolition 
of the popular but hypothetical "centre for concepts" in 
his summary of the evidence in favor of the existence of a 
cheiro- kinesthetic centre, or in his denunciation of the 
excessive importance attributed by some to Broca's, or, as 
he calls it, the glosso-kinesthetic centre, which he believes, 
and indeed shows, to be almost incapable of independent 
action. Two comparatively novel points of great interest 
come out in the course of the lectures. One is the consid- 
erable power of reciprocal substitution possessed by the 
visual and auditory word centres from the production of 



jdbyGoOglC 



Selections. 437 

speech and writing respectively; the other is the fact that 
in all probability both auditory word centres— and not, as 
formerly believed, the left alone — are accustomed to act on 
Broca's centre in the production of speech. This latter 
observation is one which paves the way to newer and 
wider views of the association of the hemispheres in gen- 
eral. — Brilish Medical Journal. 

PATHOLOGY OF BULBO-SPINAL ATROPHO- SPASTIC 
PARALYSES.— Hoche {Neurologische Cetitralblatt , March IS, 
1897) used Marchi's method for tlie study of the nervous system 
of a typical case of amyotrophic lateral sclerosis with pro- 
gressive bulbar palsy in a man, aged fifty-two years, who 
died with symptoms of vagus-paralysis a year and a half 
after the beginning of the disease. The designation in the 
title is employed in accordance with the suggestion of Sen- 
ator (Deutsche Med. ]Vochenschnft , 1894). The patient had 
presented spasticity of the upper and lower limbs with ex- 
aggerated reflexes, some atrophy of the interossei of the 
hands, fibrillary twitching, main engriffe of the left hand; 
the pupils and external ocular muscles were normal; the 
tongue showed no anomaly: sensory or sphincter disturb- 
ances were absent; mimic movements were normal; there 
was progressive impairment of swallowing and of speech, 
and towards the end persistent acceleration of the pulse. 

The gross morbid findings were unimportant. In 
Marchi's (and Weigart's) preparations the following was 
noted: A degeneration of the entire motor pathway and 
slight changes in the ganglion cells, in addition extensive 
degeneration of the fibre systems that unite the motor 
nuclei, both of the cranial and of the spinal nerves — viz., the 
posterior lorigitudinal bundle and the short tracts of the ante- 
ro-lateral columns. 

It was apparent from a combined study of Marchi's 
and Weigert's sections that the degeneration in the pyra- 
midal tracts had progressed from below upward; it could be 
traced through the corona radiata to the central convolu- 
tions. In the nuclei of the cranial nerves but little degen- 
eration of the ganglion cells was noted; in the cord the 



jdbyGoOglC 



438 Selections. 

number of cells was reduced in the cervical portion, appar- 
ently not at alt in the dorsal, while in the lumbar region 
the fibrillar net-work of the anterior horns plainly showed 
degenerative changes. 

In marked contrast with these rather insignificant cell- 
changes were the degenerations of the root fibres of the 
oculo-motor, pathetic, abducens, facial, glosso-pharyngeal, 
vagus, hypoglossus, and spinal accessory nerves. The in- 
volvement of the ocular nerves was interesting in view of 
the absence of clinical symptoms referable to the eyes, 
while those in the facial, hyperglossus, and spinal acces- 
sory were more marked than had been expected. 

The chief interest of the case lies, however, in the 
involvement of the two commissural tracts. Marie was the 
first to call attention to this degeneration in the antero- 
lateral tracts, and Brissaud went so far as to consider amyo- 
trophic lateral sclerosis as a primary disease of the supple- 
mental or commissural fibres. While withholding his full 
approval of this theory, the author believes that the chang- 
es demonstrated in the posterior longitudinal bundle in his 
case accord very well with it, for this bundle is for the 
motor cranial nerves what the short tracts of the cord are 
for the nuclei of the different spinal segments. 

The pathologic anatomy of amyotropic lateral sclerosis 
(bulho-spinal atropho -spastic palsy) may be summed up as 
follows : 

1. Destruction of the motor cortical neurons — degener- 
ation of the pyramidal tracts to their terminations. 

2. Destruction of the peripheral motor neurons — motor 
pathway from the nuclei of the cranial and spinal nerves to 
their determinations — the muscles. 

3. Destruction of the commissural cells and fibres in 
the cortex, the posterior longitudinal bundle, and the ante- 
ro-lateral tracts of the cord. 

Of the clinical phenomena which correspond to the dis- 
appearance of the commissural tracts we know practically 
nothing. — University Med, Magazine. 



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NEURONYMY. 

NEURONYMIC PROGRESS IN AMERICA.— The Ameri- 
can Neurological Association, at its recent session in Phila- 
delphia, took a step at once sure and decided toward the 
simplification and unification of neurologic nomenclature. 
The Committee on Neuronymy (Drs. H. H. Donaldson, L. 
C. Gray, C. K.. Mills, E. C. Seguin, E. C. Spitzka, and 
B. G. Wilder, chairman), presented a report which was 
adopted iDianimously by tlie Association, June 5. To give 
this important measure as wide a circulation as pos- 
sible we publish the report of the committee as furnished 
us by its chairman. 

The first five sections are substantially identical with 
reports that were adopted unanimously by the Association 
of American Anatomists in 1889 and by the American Asso- 
ciation for the Advancement of Science in 1890 and 1892. 
The recommendations are as follows: 

1. That the adjectives DORSAL and VENTRAL be 
employed in place of posterior and anterior as commonly 
used in human anatomy, and in place of upper and lower as 
sometimes used in comparative anatomy. 

2. That the cornua of the spinal cord, and the spinal 
nerve-roots, be designated as DORSAL and VENTRAL 
rather than as posterior and anterior. 

3. That the costiferous vertebrse be called THORACIC 
rather than dorsal. 

3, That, other things being equal, iHONONYMS (single 
word terms) be preferred to polyonyms (terms consisting of 
two or more words). 

5. That the hippocampus minor be called CALCAR; the 
hippocampus major, HIPPOCAMPUS; the pons varolii, PONS; 
the insula Reilii, INSULA; pia mater and dura mater, respec- 
tively PIA and DURA. 

6. That the following be employed rather than their 
various synonyms: "Hypophysis, Epyphysis (for conarium 
and corpus piiieale) , Chiasma, Oblongata, Lemniscus, Mon- 
ticulus. Tegmentum, Pulvinar, Falx, Tentorium, Thalamus, 
Callosum, Striatum, Dentatum, Mesencephalon, Pallium. 



jdbyGoOglC 



440 Selections. 

Oliva, Clava, Operculum, Fissura Centralis (for /. Rolando, 
etc.) F. Calcarina, F. Collaterals, F. Hippocampi, Cuneus, 
Praecuneus, Claiistrum, Fornix, Infundibulum, Vermis." 

It will be noted that at least twenty (about half) of 
the names above recommended coincide with those adopted 
by the European committee in 1895, and that with some 
others, e. g., Callosum, Dura and Calcar, the difference is 
due merely to the elimination of superfluous words, — Edi- 
torial in Journal of Comparative Neurology. 



NEURO-DIAGNOSIS. 

HYSTERIA DIAGNOSIS.— Strozevski, of Warsaw, claims 
considerable consistency (Universal MedkalJoumal, March, 
1897) for a characteristic symptom of this affection, one 
which, up to the present time, has not been noted. It con- 
sists of a complete abolition, or at least a very considerable 
diminution, of excitation of certain portions of the body, by 
a delicate stimulant, such as for instance, a piece of paper 
or a hair. 

If, on a healthy person, these spots are touched in this 
way, a sort of irritation or tickling is produced with a more 
or less agreeable sensation. The experiment causes the 
person to place his hand upon the place subject to the 
excitation. The most readily excited points are: the exter- 
nal auditory canal and the mucous membrane of the nasal 
fossie; then the lower eyelid and the skin of the forehead. 
The least excitable spots are: the arm-pit, the skin on and 
under the knees, and the sole of the foot. In these last 
named places Strozevski excited irritation with gentle move- 
ments of the fingers. In hysterical subjects the above 
experiment does not cause any sensation, or, at best and 
then but rarely, very slight sensation. Gilles de la Tourette 
("Traite de I'Hysterie," p. 166) briefly refers to abolition 
of the reflexes by tickling in the anesthetic regions. 
Strozevski states that he has studied this symptom in more 
than fifty cases of hysteria, and that the patient never feels 
the contact. He has never found a case of hysteria in 



jdbyGoOglC 



Selections. 441 

which this symptom was absent, not even in monosympto- 
matic hysteria the same being the case in patients, who, 
relieved of their sufferings were about to leave the hospi- 
tal. This symptom is equally present in hysteria with 
depression or with erethism and in both sexes. 

In exploring this irritability in various patients at the 
hospital Strozevski occasionally met with its partial diminu- 
tion; that is to say, a feeble reaction under the arm pit, 
the knee and upon the sole of the foot with a violent reac- 
tion in the auditory canal and the nasal fossx. This dim- 
inution only occurred in very apathetic subjects in whom 
he also observed an abolition or a considerable diminution 
of the reflex of the conjunctiva. This symptom is doubtless 
of central origin. 



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EDITORIAL. 

[All Unsigned Editorials are Written by the Editor']. 



Section on Neurology and Medical Jurispru- 
dence. — The Journal of the American Medical Association 
pays the following high tribute to the work and influence of 
this section and shows how near the day is approaching 
when Neurology will have its proper place in general medi- 
cine: — 

This is one of the younger sections of the American 
Medical AsKviation, which has already attained prominence, 
and will no doubt in the near future rival all the other 
sections in interest and popularity. Questions of neurology 
and jurisprudence are increasing in every department of 
practical medicine. The new researches of brain physiology 
give promise of therapeutic revolutions as startling as in 
any other field of medicine. At the Philadelphia meeting 
fifty-one papers were read by the authors and by title. Of 
these only three related to medical jurisprudence, three to 
the influence of alcohol on the brain and nervous system, 
and two to hypnotism. Seven papers were devoted to neu- 
rasthenia and its treatment, and three to insanity. The 
other papers were mostly devoted to diseases of the spinal 
cord and brain. The authors of the latter were very largely 
teachers of neurology, and were expected to present the 
latest and most authoritative facts on these topics. How 
far these papers together exceeded the papers read at pre- 
vious meetings of the Section, can not be easily determined. 
Evidently they were more technical, and confined to the 
more obscure lesions of the brain and cord. Some of these 
papers had a pedagogic cast, indicating unfamiliarity with 
audiences of general practitioners, and inability to isolate 
and emphasize the centra! facts of the topic. IWany excel- 
lent studies are covered up and made useless in all the 
Sections, by the inability of the reader to reach the level 
of his audience, and condense his facts so they can be 
understood without effort. The popularity of the Neurologi- 

[442] 



jdbyGoOglC 



Editorial. 443 

ca! Section has come from the fact that its wide range of 
topics have been presented by practical men and specialists, 
who avoided all effort to exhaust the subjects and sought 
rather to make prominent some particular facts. This has 
given a certain suggestiveness to the papers which were 
stimulating to all hearers. Several papers read at this 
meeting were prominent in this respect and will be read in 
the Journal with great interest. 

The officers and leading men in this Section have long 
ago recognized the need of more practical helpful papers to 
the general practitioner and members of the Association who 
yearly come to the meetings for facts and hints that can 
be used in a general evcry-day practice. It is proposed to 
have the same secretary elected every year, so he can 
become familiar with the leading men of the country who 
are members of the Association, and able to contribute 
strong papers on the topics of tlie Section. This will be 
a great improvement over the present methods, and enable 
the secretary to arrange and bring out certain topics more 
fuiiy than in any other way. Symposiums of questions 
still unsettled can be arranged and carried out, and special 
topics can be presented by leaders not readily accessible to 
a new unknown secretary. It was proposed to devote one 
or more sessions to medico-legal questions exclusively, and 
have certain topics uppermost in the public mind discussed. 
This will give a certain solidity and permanence to the 
work of the Section, which will be followed by others. 

There are probably more difficult unknown questions 
coming up in every branch of practice concerning neurology 
and jurisprudence than in any other field. The medical 
teacher will give general principles, but he is unable to go 
beyond certain narrow lines. The new problems that are 
ever coming up require the study of matured practical men, 
and discussion from all sides. This is often aptly illustrated 
in sectional meetings, where live topics bring out most sug- 
gestive spirited discussions. 

This Section, in common with other section , suffers from 
the reading of papers which are technical exhaustive studies 
of some narrow phase of the subject, which are of little 
interest, even to experts. Such papers always drive away 
the audience or put them to sleep. There are sonle quite 
prominent men whose papers are so minutely exhaustive, as 
to destroy all practical interest in the subject. Others 
equally learned have such an involved, obscure style, that 
it requires much effort to follow them. Often such writers 
present many original views which are covered up and lost 



jdbyGoOglC 



444 Editorial. 

except to some careful student who discovers them and 
announces them as his own. There follows an acrimonious 
debate of priority. The Neurological Section has started a 
movement to reform these errors, and at the next meeting 
will attempt to lead all other Sections in broad, practical 
studies and presentations of papers which will be both sug- 
gestive and helpful to all its hearers. 

The American Journal of Insanity, heretofore 
published at 34 Washington street, Chicago, was trans- 
ferred to Baltimore, July 1, 1897, and will be published by 
the John S. Hopkins Press. The editorial control wili be in 
the hands of a committee of the American Medico-Psycho- 
logical Association, consisting of Dr. Henry M. Hurd aod 
Dr. E. N. Brush, of Baltimore; Dr. G. Alder Blumer, of 
Utica, N, Y., and Dr. J. Montgomery Mosher, of Albany, 
N. Y. 

All communicatians for the Journal should be addressed 
to Dr. Henry M. Hurd, care of the Johns Hopkins Hospital, 
Baltimore, or to any of the editors. All exchanges and 
business communications should be addressed to the Johns 
Hopkins Press. Baltimore. 

The Training School for Nurses, at the Iowa 
Hospital for the Insane, Clarinda, Iowa, invited us to attend 
the graduating exercises which were held in the Hospital 
Amusement Hall, Wednesday evening, June 9th, 1897. 

While we could not attend we cordially approve of this 
good work of making trained nurses for the insane. 

MedieO'Psycbological Association of Great 

Britain and Ireland will be held at the College of Medicine, 
Newcastle-on-Tyne, July Z9th and 30th, 1897. Communi- 
cations may be sent to the general secretary, R. Percy Smith. 
One or more excursions on Saturday, July 31st, will con- 
clude the meeting. 

A Big Meeting. — Our esteemed contemporary, the 
Canadian Journal of Medicine and Surgery, has an exalted 
idea of the size of the American Medical Association. Refer- 
ring to the recent jubilee meeting W. A. Y. remarks in its 

editorial pages as follows: "This magnificent association 
wliicii is without a peer we think in the world, had by far 
its most successful convention this year, there being over 
twenty-five hundred delegates from every state in the 
Union." One hundred and twelve thousand five hundred at 
least. Thanks for the complimentary reference to our 
National Association, but the "W. A. Y." of your reckoning 



jdbyGoOglC 



is reckless and wayward. , But it was a large and glorious 
meeting and nothing was in tlie way of its success. 

We acknowledge an invitationto be present at the 
commencement exercises o( the Training School for Attend- 
ants at the Amusement Hall of the State Hospital at Dan- 
ville, Penn., Thursday July 8th, 1897, at 7:45 P. M. 

We are glad to see the good work go on, but regret 
our inability to attend. 

The Philadelphia Neurological Society ""did 
"itself proud," in the language of the border, in its treat- 
ment of the Neurological Section of the A. M. A. Besides 
its banquet and reception it presented the following intel- 
lectual bill of fare at the Neurological Society: Dr. Whar- 
ton Sinkler exhibited a case of Erb's Paralysis, Juvenile 
Form ; Dr. IVlartin W. Barr, by invitation, exhibited an 
Extraordinary Case of Echolalia; Dr. F. X. Dercum exhib- 
ited a Case of Cortical Hemianopsia and a Case of Unilat- 
eral Disseminated Sclerosis; Dr. James Hendrie Lloyd 
exhibited a Case of Tremor in a Man Exposed to Lead; 
Dr. Charles W, Burr exhibited a Case of Hemiplegia, 
probably Hysterical, with True Ankle Clonus; Dr. Charles 
K. IWills exhibited a case of Paralysis of the Elevators of 
the Eyeballs and Two Cases of Painless Facial Tic; Dr. 
Joseph Sailer reported a Case of Gliosis Cerebri and Dr. 
William G. Spiller read a communication from Dr. Marin- 
esco, of Paris, on the Pathology of Morvan's Disease. 

William W. Ireland's Early Honors.—? fie Stols- 
mau of June 3rd ultimo, speaking of a proposed dinner iit 

Delhi to commemorate that immortal seige, says: 

On that occasion a young Edinburgh boy so distin- 
guished himself that he received the Victoria Cross. * * * 
Another Edinburgh youth, a graduate of the University, was 
there, Dr. Ireland, since well known professionally and in the 
literary world. He was afterwards returned as one of the 
killed in the battle of Nujjufgarh, jnd wrote the "History 
of the Sieye of Dellii, by an officer who served there." 

Dr. Ireland has been a frequent and much valued con- 
tributor to this journal. He is especially well known by his 
books, "Through the Ivory Gate" and "Blot Upon the 
Brain," 

Schlatter Dead. — This insane religious enthusiast and 
"Divine Healer" who had such a remarkable career in Den- 
ver, Colorado, in 1895, has been found dead from persistent 



jdbyGoOglC 



446 Editorial. 

fasting in the mountains near Casa Grande, Mexico. Fol- 
lowing is something of his record from the New York Tri- 
bune: 

While in Denver, from August 22 to Nov. 13, 1895, 
about tliree hundred thousand people visited Schlatter. 
Francis Schlatter was an Alsatian peasant, ordinarily edu- 
cated and intelligent, who came to this country several 
years ago and settled in Jamesport, Long Island, as a shoe- 
maker. His record in Jamesport was good. He was addicted 
to no bad liabits, made excellent shoes, paid his way and 
saved money. He was in love with a young woman, who, 
however, refused to marry him. In the society of the vil- 
lage he was known as a good fellow with queer views who 
could "talk like a book." He had "visions," also, and 
had much to say about the great questions of life and des- 
tiny. But at this time he made no pretensions to the pos- 
session of any unusual powers. In 1894 he went to New 
Mexico, and was next heard of as a wonderful "New Mes- 
siah," with an extraordinary power of curing diseases. He 
at once became locally famous. It is said that he was 
imprisoned in that Territory for falsely claiming divine 
powers. However that may be he went to Denver in the 
summer of 1895, and his career there attracted widespread 
public interest. His presence made Denver the central point 
to which journeyed thousands of sick and afflicted from all 
over the country. Schlatter lived in Denver with Alderman 
Fox, and gave public "treatments" in a hall or theater, at 
which an admission fee was charged. Then there were 
"treatments" to all who came to Mr. Fox's house. He 
became known as the "New Messiah, and "The Healer." 
He blessed handkerchiefs, and it was said that any one 
touching these handkerchiefs would be "healed." "Fakirs" 
did a thriving business in this line. They advertised "bles- 
sed handkerchiefs" for the small sum of $1, and raked in 
hundreds of dollars, until they were arrested by the author- 
ities. Schlatter was wanted as a witness in this case, and 
many thought that he disappeared from Denver on Novem- 
ber 13 because he did not want to testify. He left a note 
in his handwriting saying: 

Mr. Fox — My mission is finished. The Father takes 
me away, Goodby. Francis Schlatter. 

After he disappeared from Denver Schlatter was reported 
at various times in the mountains of Arizona and New 
Mexico, and many weird stories were told of his flight. 
Many remarkable stories were told of cures made by Schlat- 
ter in Denver. On the last day he was in the city he 



jdbyGoOglC 



Editorial. 447 

"treated" no fewer than five thousand people. He did not 
profit in a worldly way by his months of self-imposed 
labors, which were of an extremely fatiguing nature. After 
the six hours daily spent in standing at the head of tlie 
line, clasping the hands of his visitors, he retired to the 
house, rested for a time and then set to work upon his 
mail, answering letters until long into the night. That mail 
is estimated to have amounted toward the end to over forty 
thousand pieces a day. 

Asexualization for Crime. — Leonard's Illustrated 
Medical Journal gives the following bill, which has been 
introduced in the legislature of Michigan, and has a fair 
chance to become a law: 

Section 1. The people of the State of Michigan enact, 
That all persons inmates of the Michigan Home for the 
Feeble Minded and Epileptic, and all persons who shall here- 
after become inmates of said Home for the Feeble Minded 
and Epileptic, that each and every person confined in said 
institution, and before .he or she is discharged, shall be 
caused to submit to an operation that causes asexualization, 
that such persons shall cease to be able to reproduce their 
kind. 

Sec. 2. All persons who shall have been convicted of 
a felony a third time, and so stated by the court, the first 
or second conviction having been committed in this State or 
some other State of 'the United States, upon conviction and 
sentence to a Michigan State prison, all of such persons so 
convicted and sentenced at a time prior to the expiration of 
such known third sentence, shall be caused to submit to an 
operation that causes asexualization and stops their ability 
to reproduce their kind. 

Sec. 3, The superintendent, warden or other person 
having charge of such Home for the Feeble Minded and 
Epileptic, and such prisons as shall contain such persons as 
provided for in Sections 1 and 2 of this act, the medical 
superintendent in charge of said institution shall perform or 
assist in the performance of the same any physician or sur- 
geon of this State. The Superintendent, warden or other 
person in charge of said institution may pay to such opera- 
tor a sum not more than twenty-five dollars for each and 
every operation so performed; and in no case where the 
operation is performed by the physician employed regularly 
by the within named institution shall there be paid any 
extra compensation. 

Sec. 4. In each and every case before such operation 
shall be performed, if the person be feeble minded or an 



jdbyGoOglC 



448 Editorial. 

epileptic confined within a prison in this State, the matter 
shall be presented in writing to the board of control of such 
institution, wherein it shall be shown that such operation 
would benefit the subject physically and morally, or that it 
is necessary as a restrictive measure to prevent propogation 
of any kind in case the subject is discharged from the 
institution. The board of control, shall, after being satis- 
fied of the advisability of such operation, authorize the med- 
ical superintendent to perform the same, after first giving 
notice in writing to the parents or guardians of such per- 
sons at least ten days before such operation. 

Sec. 5. That whoever shall have been convicted of the 
crime of having ravished a child or woman while upon the 
streets of any city, village, public highway or any other 
place within this State, it shall be the duty of the judge 
making such sentence to include in such sentence that within 
one year after being confined in such prison, an operation 
which causes asexualization shall be performed as provided 
in Section 3 and 4 of this act. 

Sec. 6. The penalty for non-compliance of this act 
shall be just cause for removal and forfeiture of the position 
of such superintendent, warden or other person named in 
this act. 

Gimlette will not bore you, but enlighten you, if you 
are interested in Myxcedema and the thyroid gland; and you 
may BETT-ON MASSEY, If you are inclined to the study of 
electrolysis and electro-cataphorosis for the removal of mor- 
bid growths. 

Mississippi Valley Medical Association. — The 

next meeting of the Mississippi Valley Medical Association 
will be held in Louisville on October 5. 6,. 7, and 8, 1897. 
All railroads will offer reduced rates. The coming meeting 
promises to be the most successful in the history of the 
Association. This is a growing body and the hospitality of 
Kentucky doctors assures a pleasant and profitable time to 
all who go and a hot time in the old Kentucky town of 
nights at least, white the Association is in session. The 
address on Surgery will be delivered by Dr. J. B. Murphy, 
Chicago; the address on Medicine by Dr. John V. Shoe- 
maker, Philadelphia. 

The Foreign Cult in American Medicine.— The 

Journal of the American Medical Association has a pertinent 
editorial on this subject from which we somewhat copiously 
extract with commendation, especially to the younger men 



jdbyGoOglC 



Editorial. 449 

of the profession in the department of Psychiatry and Neu- 
rology. 

The latest published utterance of a recently deceased 
American naturalist, who was second to none in the 
specialties he had adopted, and was furthermore one of the 
most philosophic and broadest in his culture, was a protest 
against a tendency that appears to exist among scientific 
students to overestimate the value of the study of the infin- 
itesimal and the culture of Europe as compared with our 
own. If this is true amongst scientific men it is much 
more so in medical circles, and his essay may well serve to 
point a moral for the consideration of our profession. It is 
abundantly true that an American who is properly fitted can 
learn something abroad, as the converse is also true that 
the European could learn something here, if lie only could 
get that fact into his consciousness. 

With those who really profit by European study no 
one would need to quarrel, but for the fact that even 
among these there are some who, through want of mental 
balance or some other defect, come back with an undue 
estimate of themselves and a disparaging opinion of their 
own country and countrymen. A "certain condescension in 
foreigners," humorously noted by Lowell, can be endured, 
recognizing the fact that it is generally a characteristic of 
second rate individuals, but to have it encouraged by the 
peculiarities of our own compatriots is not at all gratifying 
and is much less endurable. 

Professor Cope's protest against the undue magnifica- 
tion of microscopic research Is also valid in medicine; we 
have the same tendency to correct. Section cutting and 
staining learned abroad no more makes a pathologist than 
it does a biologist, and it is in medicine, as in science, not 
less really scientific to observe properly with the naked eye 
than "through a brass tube furnished with lenses." The 
overestimation of the latter method is responsible for the 
waste of much patient work and expense, and this is espe- 
cially true in medical science. What we need is not less 
careful pathologic work, but more and better clinical obser- 
vation to guide and interpret it, and it is easier to make a 
trained microscopist than a really skilled clinician. As it is, 
however, it often happens that a manual skill and dexterity 
in microscopic work is valued above far more important and 
difficult accomplishments, simply because it is more showy 
and requires the use of elaborate paraphanalia that are be- 
yond the reach of the many. 

There is a possibility of becoming eminent In medicine 



jdbyGoOglC 



450 Editorial. 

without a European polish to our professional education, 
but there is a slowness in certain quarters and certain indi- 
viduals to recognize this fact. Indeed it is even now a 
matter of surprise and comment amongst some high Euro- 
pean authorities that there should be such a lack of recog- 
nition, but it is not their interest to complain. The time, 
however, will come when American centers of medical edu- 
cation will draw European students, and at the present rate 
of progress it may not be so very far distant. The sooner 
it appears the better, and we can best aid its coming by 
discouraging the dishonorable depreciation of what is really 
good in our own country, and the too prevalent cult of a 
foreign fantasy in matters of medical science and education. 

The American Medical Association Semi-Cen- 
tennial which closed on June 4, was the event of the 
year's history thus far made. Between two thousand and 
three thousand members were in attendance and probably 
fifteen hundred more members might have been secured had 
a larger time limit, say sixty days, been secured on return 
tickets. It met at or near the time when members go from 
home for their summer outing. Many could not arrange to go 
at this time and then go later away from home and many did 
not wish in these trips to pay full rates for return. This 
matter should be better arranged for the next year meeting 
at Denver, for there will be much to see and many side 
trips to be taken when we go to the Queen City of the 
Rockies and the hospitable hands of Denver physicians 
will not let us go back to our homes so soon as we had to 
from Philadelphia much to our regret, and no fault of the 
Philadelphia profession, but of the short-sighted parsimony 
of the railroads. A more liberal return limit would have 
kept half the Association at Atlantic City or elsewhere on 
the sea coust till June's hot days had passed. 

Everything went well in the City of Brotherly Love, 
but the transportation faux pas. The addresses of Drs. 
Flint, Keen and Senn were admirable. Dr. Davis was in his 
glory almost pristine, the honored semi -centenarian founder 
and Father of the Association, erect, manly, vigorous, 
scarce showing the weight of years and pressagine in his 
intelligent presence and manly carriage a long life of useful 
days yet to come. Guion, the indefatigible, secured a hand- 
some subscription to the great Rush monument; the section 
work was excellent, surpassing all previous years; the 
judicial council judged wisely for the welfare of the Asso- 
ciation, and the receptions and social features pleased all to 
repletion and filled to satisfaction every soul. The Profes- 



jdbyGoOglC 



Editorial. 451 

sion of Atlantic City showed their accustomed handsome hos- 
pitality in taking all who wished to go and rest a day by the 
sea and recuperate. The selection of Surgeon General 
Sternberg for the next president was a worthy one timely 
bestowed. The army and its distinguished medical chief 
merited the honor, and no better place for the next meet- 
ing than Denver could have been selected. The East, the 
West, the North, the South and the great central valley of 
the country, wilt clasp fraternal hands there in the heart of 
the Rockies and enjoy the invigorating influence of renewed 
friendships, mountain air and unsurpassed Denver hospitality. 

To Castrate the Crippled in Mind is the aim of 

Mr. Edgar, of the Michigan Legislature. He proposes this 
remedy for all inmates of the State Home of the feeble- 
minded, the epileptic, for the rapist and for incorrigible 
criminals. 

How to get around the constitutional provision against 
maiming for crime is the question. As a remedial measure 
it might be admirable in certain cases of cerebro- mental 
disease and as a choice to the convicted of capital crime 
punishable with death, it might be permitted by the law 
and rape might be made a capital crime. It is the proper 
prophylaxis against social neuropathic decadence and crimi- 
nal degeneracy and ought to be provided for by law wher- 
ever it can be made a constitutional possibility. 

Selected Good Advice. 

If you've got a thouKtit that's happy. 

Boll it down; 
Make it short and crisp and snappy, — 

Boll It down. 
When your brain fts coin has minted. 
Down the page your pen has sprinted. 
If you want your effort printed, 

Boil It down. 

Take out every surplus letter, — 

Boil it down; 
Fewer syllables the better,— 

Boil it down. 
Make your meaning plain, — explain it 
So we'll know, not merely guess It; 
Then, my friend, ere you address It, 

Boil it down. 



jdbyGoOglc 



452 Editorial. 

Boll out *1I the extra trimmings,— 

Boil It down ; 
Skim It welt, then skim the trimmings, 

Boll it down. 
When you're sure 'twould be a sin to 
Cut another sentence Into, 
Send It on, and ae'U begin to 

Boll It down. 

— Canadian Journal of MtdUini and Snrgnyi. 

Twelfth International Medical Congress, Mos- 
cow. — The Czar has taken the Congress under his protec- 
tion and the delegates are to be presented to him by the 
ambassadors from the various countries. All members of 
the Congress are to be carried free from the frontiers to 
Moscow and return, and no customs levied on instruments 
or small quantities of drugs. {SI. Petersburg Med. Woch., 
May 8.) 

The program announced by the Section for Nervous and 
Mental Diseases is as follows: 1. Pathology of the Nerve 
Cell, Van Gehuchten, Belgium ; Dana, New York ; Van 
Giesen, New York. 2. Syringomyelia, Schultze, Bonn; 
Schlesinger, Vienna ; Minor, Moscow, 3. Tabes Dorsalis, 
Obersteiner, Vienna; Pierret, Lyons; Erb, Heidelberg; 
Grassett, Montpelier ; Althaus, London ; Darkschewitsch, 
Russia; Borgherini, Padua; Eulenburg, Berlin; Benedikt, 
Vienna; Raichline and Hirschberg, Paris. 4. Operative 
Treatment of Diseases of the Brain, Oppenheim, Berlin; 
Sachs, New York; Voisin, Paris. 

Addresses on other subjects will be given by Lombroso, 
Turin; Crocq, Brussels. 1. Hallucinations and Fixed Ideas, 
Pitres and Regis, Bordeaux; Shaw, Liverpool. 2, Paralysis 
of the Insane, Binswanger, Jena; Althaus, Homen, Helsing- 
fors ; Muratow, Moscow. 3, Hypnotism and Suggestion, 
Bernheim, Nancy; Tokarski, Moscow; Robertson, Glasgow; 
Gorodichze, Paris. Other speakers: Morel, Ghent; Furst- 
ner, Strasburg, Francotte, Li^ge; Shuttleworth, England; E. 
Christian, France; Meschede, Germany: Leyden, Berlin; 
Henschen, Upsala; Ballet, Paris. 

The Section on Neurology and Medical Juris- 
prudence of the American Medical Association was unus- 
ually well attended, the program was extraordinarily good 
and full embracing the following papers and subjects with 
instructive discussions: — 

Tuesday, June 1st — Chairman's Address, Dr. W. J, 
Herdman, Ann Arbor, Mich.; History of the Section on 



jdbyGoOglC 



Editorial. 45 J 

Neurology and Medical Jurisprudence, 6r, J. G, Kiernan, 
Chicago; History of American Neurology, Dr. C. H. Hughes, 
St. Louis; *On the Pathogenesis of Locomotor Ataxia, 
Dr. L. Harrison IV\ettler, Chicago; Anresthesia in Locomotor 
Ataxia, Dr. Charles W. Burr, Philadelphia; *The Paralyses, 
by One of the Many Paralytics, Dr. Samuel Knox Crawford, 
Chicago; Internal Cerebral Meningitis Chronica, Dr. E. S. 
Pettijohn, Alma, Mich.; The Differential Diagnosis between 
Cerebral Syphilis and General Paresis, Dr. Hugh T. Patrick, 
Chicago; Hereditary Lateral Sclerosis, Dr. AugustusA. Eshner, 
Philadelphia; A Case of Thomsen's Disease Complicated by 
Multiple Neuritis, Dr. M. Nelson Voldeng, Des Moines, Iowa; 
Pain Traumatisms, Dr. Thomas H. Manley, New York City; 
Melancholia and its Treatment, Dr. W. S. Watson, Fish- 
kill-on-Hudson, N. Y. 

Wednesday, June 2nd. — Aphasia, Dr. Charles K. Mills, 
Philadelphia; Discussion, Drs. F. X. Dercum, Hugh T. 
Patrick, William G. Spiller, Wm. Fuller, E. G. Carpenter, 
and W. J. Herdman; French and Motor Aphasia in a Polyglot, 
Dr. F. Peterson, N. Y. City; *The Subconscious Mind, 
Clark Bell, Esq., New York City; *Some States of Disturbed 
Consciousness, Dr. J.. T. Eskridge, Denver, Col.; ♦influ- 
ence of Hypnotic Suggestions upon Physiological Processes, 
Dr. R. Oscar Mason, New York City; *Expertism, Dr. S. V. 
Clevenger, Chicago; *A Synopsis of the Duestrow Case, 
Dr. L, Bremer, St. Louis; The Medico-Legal Aspect of Cho- 
reic Insanities, Dr. C, C. Hersman, Pittsburg, Pa,; Insanity 
and Pulmonary Consumption Among the Negro Population 
of the South Since the War, Dr. Thomas J. Mays, Phila- 
delphia; Remarks on the Curability of Insanity, Dr. John 
Punton, Kansas City, Mo.; (a) Alcohol as a Causative 
Factor in Disease of the Central Nervous System, (b) 
Inebriety and Tuberculosis as Allied Diseases, Dr. T. D. 
Crothers, Hartford, Conn. ; *The Status of the Present 
Treatment of Alcoholism, Dr. J. K. Bauday; *StLgmata in 
Young American Degenerates, Dr. Eugene S. Talbot, 
Chicago, 

Post-mortem Findings in a Case of Trauma of the Cer- 
vical Region of the Spinal Cord Simulating Syringo-myelia, 
Dr. J. H. Lloyd, Philadelphia; Meningomyelitis with Special 
Reference to the Tubercular Form, Dr. William G. Spiller, 
Philadelphia. 

Thursday, June 3rd. — Neurasthenia, Essentialis and 
Neurasthenia Symptomatica, Dr. F. X, Dercum, Philadel- 
phia; A Study of the Symptomatology of Neurasthenia in 

'Rend by lille. Author ibttnl. 



jdbyGoOglC 



4 54 Editorial. 

Women, Dr. Louis F. Bishop, New Yorl< City; Clinical 
Evidences of Neurasthenia as an Abdominal Neurosis, Dr. 
G. Betton Massey, Philadelphia; Function of the Nerve 
Cell, Dr. Wm. B. Hall, Jr., Sewanee, Tenn. ; The Caus- 
ative Factors in Disease of the Ceotral Nervous System, 
Dr. Geo. H. Rohe, Syl<esville, IHd. ; *The Use and Abuse 
of Electricity in the Treatment of the so-called Neuroses, 
Dr. L. Harrison Mettler, Chicago; The Rest Cure, Dr. Lan- 
don Carter Gray, New York City; Discussion: Drs. Chas. 
K. Mills, Douglas, Graham, Pierce, Watson and C. H. 
Hughes; Rest and Northern Lake Air for Neurotics, Dr. E. 
S. Pettyjohn, Alma, Mich.; Treatment of Graves' Disease, 
Dr. Herold N. Moyer, Chicago; Discussion: Drs. A. A. 
Eshner and C. H. Hughes; Habit Spasms of Children, Dr. 
Samuel J. Fort, Ellicot City, Md.; A Study of the Devel- 
opment of Some Common Psychoses of Childhood into Per- 
manent Criminal Tendencies, Dr. J. Francis Calif, Middle- 
town, Conn. ; Hypnotism in the Treatment of Disease, Dr. 
U. O. B. Wingate, Milwaukee. 

Friday, June 4th. — Rumination in Man, Dr. Wliarton 
Sinkler, Philadelphia; tTumor of the Spinal Meninges, Drs. 
Chas. K. Mills and Aloysius O. J. Kelly; tU) Fibroma of 
the Dura, {b) Syphiloma of the Dura, (c) Glioma of the 
Thalamus, Drs. Chas. W. Burr and Aloysius O. J. Kelly; 
tTumors of the Cerebellum with the Report of a Case, Dr. 
Aloysius O. J. Kelly; tA Clinical and Pathological Report 
of a Case of Chronic Progressive Non-specific Dementia 
with Arterio- sclerosis, Drs. Chas. K. Mills and Mary Alice 
Schively; lA Case of Parc'tic Dementia with Autopsy, Drs. 
Chas. W. Burr and J. H. W. Rhein; tTumor of the Basal 
Ganglia, Drs. Chas. W. Burr and Carl Ohnesorg; tTumor 
of the Spinal Meninges, Drs. Samuel W. Morton and A. 
Ferree Witmer; {a) A Contribution to the Pathology of 
Myelitis, Acute and Chronic, (b) Lesions of the Spinal Cord 
Due to Tubercular Disease of Column, With IVlrcroscopic 
Specimens, Drs. John K. Mitchell and John H. W. Rhein, 
Philadelphia; Tremor in Chorea, Dr. John H. W. Rhein, 
Philadelphia. 

For the coming year Dr. C. H. Hughes, of St. Louis, 
was elected president and Hugh T. Patrick, of Chicago, 
Secretary. 





• Read by Iltri 


>. AuUx., 


■ iibient. 


.,.„. 


tFrom ih« Stco 
Members al th( 


.nd Repo 
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Tiof theN 



t Pblladelphli Paly- 



jdbyGoOglC 



Reviews, book Notices, et(. 



HYSTEftt* AND CERTAIN ALLIED CONDITIONS— THEIR NATURE AND TREAT- 
MENT, WITH Special reference to the application of the Rest 
CURE, Massage, Electrotherapy, hypnotism, btc. Illustrated. 
By George J. Preston. M. D., Professor of Diseases of the Nervous 
SyBtem, College of Physicians snd Surgeons, Baltimore; Visiting Phy- 
sldan to the City HospiUl; Consulting Neurologist to Bay View Asy- 
lum, The Hebrew Hospital, The Church Home and Infirmary, etc.; 
Member of the Medical and Chirurgical Faculty ol Maryland. The 
American Neurological Association, etc. P. Blaklston, Son & Co., Phil- 
adelphia, Publishers. 

This little volume of nearly 300 pages presents the symptomatology and 
dlRerential diagnosis of hysteria in a clear and concise manner, and Indicates 
the various therapeutic measures useful In the treatment of this disorder In 
detail, thus subserving the needs of the general practitioner In particular, 
for whom the work is especially intended. 

Regarding surgical interlerence In the treatment'of hysteria, Dr. Preston 
writes as follows: 

It has been shown that in the accidents ol hysteria, such as paralysis 
and contracture, surgical interference Is entirely unwarrantable. It may 
happen. In rare Instances, that there Is actual shortening of ihe tendons in 
contracture requiring tenotomy, but this Is altogether exceptionable. Sur- 
gical operations are rarely ever thought of after the diagnosis of hysteria is 
made in the case of the two conditions mentioned above. Far different has 
been the history of operations upon the organs of reproduction (or the cure 
of hysteria. As has been shown, the early authors attributed hysteria to 
Hie migrations of the uterus, and had the operation of hysterectomy been 
known or been possible at the time, it would, no doubt, have been frequently 
resorted to. As it was, the treatment of hysteria often had in view the 
supposed disease of the genital organs. "Nubal ilia tt morbum cffugitl." 
said Hippocrates, an^ Forestius gives minute directions lor the " confriatio 
Tuiva." These efforts at treatment were simply the logical outcome of the 
Ignorance respecting the nature of the disease hysteria, and were excusable. 
It is, however, almost Incredible that in the light ol the nineteenth century 
surgeons should endeavor to cure a disease which is admitted to be in the 
brain by operating upon the organs of generation. And still the ' 'operating 
frenzy" is not spent. Just as in the cases mentioned in another chapter, 
[455] 



jdbyGoOglC 



456 Reviews, Book Notices, Etc. 

in which perfectly healthy breasts have been removed for a supposed disease 
which was really in the mind of the patient, and as joints have been laid 
open and muscles and tendons cut for hysterical contractures, so Innumer- 
able healthy ovaries have been removed for hysterical pain situated In this 
region. Without perceivlni it, the effort has been made to remove, by the 
knife, an hysterogenic zone, it became obvious, after a time, that the 
mere existence of pain In the region of the ovary was not sufficient cause 
for operation, so the endeavorwas made to show some evidence of disease — 
a minute cyst, or some other utterly trivial condition. 

Most of us were familiar a few years ago with this sort of "Eynecol' 
oglcal pathology." After a time the view that the ovaries in hysteria were 
diseased had to be abandoned. Then the position was boldly assumed that 
the removal of the ovaries, though healthy, was good practice in the treat- 
ment of hysteria and other mental diseases. For a time this dictum was 
vigorously promulgated, and the attack upon the healthy ovary In the hys- 
terical subject became notorious, in this country, where so much attention 
has been paid to gynecology and so little to hysteria, this most unwarrant- 
able operation has beed resorted to with disgraceful frequency, and if it 
were necessary, long lists of published cases, operated on for the cure of 
soae neurosis, could be given. Most unfortunately a certain proportion of 
these operations were successful in relieving the hysterical symptoms for a 
time, but for a very different reason than the one assigned. As has con- 
stantly been pointed out, the central idea In the treatment of hysteria is 
suggestion, and our constant aim is to make a strong mental Impression. 
Take, now, the hysterical' woman: let her undergo this most grave operathtn, 
knowing often a good deal of what removal of the ovaries implies, feeling 
that her life Is to undergo a marked change; let her pass through the 
impressive preparation lor the operation, and after the operation be kept In 
bed for several weeks and well nourished. Could any more impressive 
treatment be devised I 1 have often heard gynecologists gravely assert that 
the surgical procedure alone was responsible lor the success. It is well 
known that the suggestive effects of the operation have been successfully 
employed, the patient being prepared, anesthetized, and bandaged up. no 
operation, or sometimes only a slight cut, having been made. It Is not the 
place here to discuss the mortality ol the operation for the removal of the 
ovaries, but one of the arguments that is sometimes offered in support of 
this mode of treating hysteria is, that the removal of the ovaries is perfectly 
safe. It may be said that the statistics from which the mortality tables 
have been taken are generally those ol very skillful operators. If all the 
cases operated upon by unskilful and ignorant men were included, the mor- 
tality would show a far higher figure. The (act that this unwarrantable 
operation was for a number of years so strongly advocated by many able 
men, spread the fame of It far and wide among the laity, and a neurologist 
is asked in most of his bad cases of hysteria whether It had not better be 
resorted to. Again, the cases of complete anJ permanent cure are limited 
jn number, and must be. since the operation has simply for the time acted 



jdbyGoOglC 



Rfviews, Book Notices, Etc. 457 

upon the higher brain centers in a suggestive manner, but has not removed 
the cause of the disease. 

In the vast majority of cases the hysterical symptoms return, and often 
the ovarian pain comes back In the place where the ovaries ought to be. 1 
could give many cases even from my own experience if space permitted. I 
will refer to two only: one a case that has already been mentioned as 
illustrating hysteijcal lethargy. In addition to this symptom the gtrl had 
anesthesia and very marked hysterogenic zones. Ovariotomy was pei- 
fonned upon her, and she was dismissed as cured. Some six months or a 
year after I Inquired of her mother as to her condition, and was told that 
she had suffered a relapse and had been taken to a hospital, where she had 
been entirely cured by electricity. The case has passed from my observa- 
tion, but doubtless the girl has been cured In many different ways since. 
The other case was a woman with certain Irregular symptoms. She had, 
however, well-marked hysterogenic zones. While under my care I dis- 
covered a floating kidney. She Improved somewhat and left the hospital. 
I next saw her in another Institution anif learned that she had had her 
ovaries removed, but the hysterical stigmata were still present. Subse- 
quently another surgeon opened her belly the second time and removed the 
floating kidney. After all this, she told me that she was about In the same 
condition as before the operatloB. These are two cases taken at random, 
but they Illustrate the point. 

Twenty years ago neuroses in wcmen were supposed to be due to a 
stenosis of the os uteri, and Instruments were devised to enlarge this pas- 
sage. After a time this operation fell into disuse and all nervous women 
who had even the most minute tears In the cervix were told that this was 
the source of the trouble— the /dhj el origo of their nervousness. Then 
came the day for trachelorrhaphy, which was practiced to an absurd degree. 
Again, the operation of removal or cauterization of the clitoris was at one 
time frequently resorted to as a cure for hysteria. To-day these operations 
have sunk intowell-merited oblivion, except in cases where there is a distinct 
Indication for them. They are no longer performed tor the relief ot the 
purely nervous symptoms. The same history might be given of the use and 
abuse of the pessary. In a previous chapter, the attempt has been made to 
show why women are apt to refer their ills to the reproductive organs. 
The mystery attached to the organs ol generation and the monthly discom- 
fort* of menstruation make these organs the source of suggestion. This 
explains the extreme readiness of hysterical women to submit to operations. 
In hysterical and neurasthenic men it Is extremely common to hear com- 
plaints relative to the sexual organs, and yet the operation of castration 
has never been in danger ol becoming papular among men. The other side 
of the question— for there is another side^which must be considered Is to 
what extent actual disease of the reproductive organs is responsible for 
hysteria. It is extremely doubtful whether any form of ovarian or uterine 
disease ever caused hysteria in a person not predisposed to this or other 
neurosis. On the other hand, there can be no doubt that ovarian and uterine 
disease or displacement may act as reflex causes and thus aggravate the 



jdbyGoOglC 



458 Reviews, Book Notices, Etc. 

existing hysteria or even bring on an attack In Individuals predisposed to 
it. It goes without saying that such actual disease of the organs of repro- 
duction, or. in fact, any irritating cause, should be especially looked alter 
in hysterical subjects. 

The rule.then, that should be adopted Is that operations should not be 
performed on hysterical women for the relief of the nervous symptoms unless 
some distinct disease of the reproductive organs can he detected. 

EYE-STRAIN IN HEALTH AND DISEASE; With special Reference to the Amel- 
ioration or Cure of Chronic Nervous Derangement Without the Aid ol 
Drugs. By Ambrose L. Ranney, A.M., M.D., Author of "Lectures on 
Nervous Diseases" ; Late Professor of Nervous Diseases in the Medical 
Department at the University of Vermont. Illustrated vith thirty-elEht 
wood-cuts. The F. A. Davis Co., publishers. 

Mark A. Brown, reviewing this book In the Cincinnati Lanc*t Clinic. 
says: "Coming tram a neurologist, a work on eye-strain can hardly tali to 
be of interest; when, In addition,' the neurologist has reached the height 
attained by Dr. Ranney, his opinions can not be looked upon with other 
than respect. The theories advocated by the author are defended, even 
proved, by the introduction 'of numerous cases bearing on the special subject 
which may be under discussion. These cases show that his treatment ot 
chronic nervous affections, headache, neuralgia, chorea, epilepsy, nervous 
prostration, insanity, by correcting errors of refraction, by prisms, by grad- 
uated tenotomies, have been attended by results remarkable even In this 
age of surprises, 

"The author rightly advocates that every specialist in nervous diseases 
should be able to detect and correct ordinary refractive errors and weak- 
nesses of the extrinsic ocular muscles. 

"The statements made In the histories of • numberiof cases that the patient 
had been treated by skilled specialists for long periods of time, and the 
publication of letters from gratelul patients are not in good taste to say 
the least. 

' 'Altogether, the book Is one that can be read both by oculist and neurol- 
ogist with considerable profit." 

We have to say further that going from home to new environments has 
much to do in promoting improvements. Patients go away to spas and 
Improve on water they would get sick on at home. They go to sanitaria 
and Improve on the recreation and relaxation and changed and cheering en- 
vironment they badly needed, but never before received in their lives— the 
solitary farmer's wife, the sedantary school teacher and routine broken bus- 
One ol our patients afflicted with melancholic hypochondriasis and 
profound general neurasthenia, went to Stevens, "got his eyes trimmed," 
as he called it, and (elt better. He went again, said Dr. Stephens promised 
him a cure. He got back homeward as far as Chicago and blew out his 
brains. We could have cured him if we could have got him Into an institution 
for the Insane or could have continuously maintained a steady course of 



jdbyGoOglC 



Reviews, Book Notices, Etc. 459 

tnuiqulljzlng and sustatning; neurotherapy. The trimming of tti« eyes Is sit 
right, errors or accomiDodatlon should be corrected and every other abnonDal, 
eye condition, but as many functional eye conditions come from altered tone 
as from changed eye function. The true therapy is to treat the patient as 
well as any defective spot in his anatomy which may be discovered. 

TEXT-BOOK OF MENTAL DISEASES. By Theo. H. Kellogg, A. M., M. D., 
late medical superintendent of Wiilard State Hospital, etc. , etc. Octavo 
792 pages, illustrated by original sphygmographic tracings and photo- 
graphs of the different types of mental disorder. Extra muslin, |6.00. 
It Is many years since an original American work on this subject has 
appeared, and this is the more surprising since the science of iqenlal dis- 
eases is one that advances rapidly and has counted among Its votaries 
many eminent American alienists and one of the world's pioneer psychiaters 
In the person of Dr. Benjamin Rush and one of the leading medico-jurists 
of Insanity In Isaac Ray. The present treatise aims to be a practical guide 
to the diagnosis and treatment of all the various types o( insanity met with. 
While reflecting a knowledge of all the relevant psychological facts of recent 
English or foreign literature, the work Is, above all, a practical treatise 
written tor the use of practitioners and students of medicine. Dr. Kellogg's 
long experience while holding prominent positions in large hospitals for the 
insane, both public and private, as well as during many years' private 
practice in the treatment of mental affections In New York City, has In an 
eminent degree qualified him for the preparation of a work on this subject. 
A table of contents and a copious Index give ready access to the matter 
contained In the volume. 

Wm. 



The JULY MON1ST. Prof. Jacques Loeb, of the University of Chicago, 
offers in the leading article of the July Monist a theory of "Egg- structure 
and the Heredity of Instincts," which bids fair to be a decided improvement 
upon the complicated doctrine of Weismann. He explains marvelous inher- 
ited acts by stmply assuming polar differences ol chemical constitution in the 
egg, and the presence there of heliotroptc, chemotropic, etc. , capacities. 

Dr. Woods Hutchinson's article on the "Value ol Pain" is as striking 
In Its homlletic as It is in its scientific point of view. The eloquent author 
draws some profound ethical conclusions as to the function of pain In life. 

"Man as a Member of Society," by the distinguished French anthropol- 
ogist, Dr. Paul Toplnard, is an exhaustive review of man's development 
from the crude beginnings of society down to the highest Intellectual culture 
of the present. 

Dyer D. Lum's posthumous paper, "The Basis of Morals," shows him 
to be a thinker of great ability and reach. 

Dr. Paul Cams translates the old Chinese philosopher, Lau-Tsie's 
"Tau-Teh-Klng," or the Classic on Reason and Virtue. The old Chinese 



jdbyGoOglC 



460 Reviews, Book Notices, Etc. 

ways of thinking are not our ways, and the utterances of Lau-Tsie will give 
the modern reader many a hard nut to crack. 

The "Conflict of Races," current French philosophy and book reviews, 
afford a critical picture of contemporary thought. The Open Court 
Puttlishing Co., Chicago. Single copies, SOc; annually, |2.00. 

The menopause, a consideration of the phenomena which occur to 
women at the close of the child-bearing period, with Incidental allusions to 
their relationship to menstruation, also a particular consideration ol the 
premature (especially the artilicial] menopause. By Andrew F. Currier, A. 
B., m. D., New York City. D. Appleton i Co., Publishers. 

The author refutes the traditional teaching that Che menopause Is a 
serious period of a woman's life, and says; "The menopause Is not a dan- 
gerous time or experience tor the majority of women, any more than puberty 
Is. It is only the exceptional woman who has a hard time." He contributes 
a chapter on artificial menopause, caused by removal of the ovaries, a 
subject to which little attention has been given in previous books on this 
subject. In the chapter on treatment he advises surgical interference, 
saying, "There are many cases which can and should be relieved 
by such measures, and it is hardly Just, or scientific, or humane, to 
load them down with drugs month after month, in the most empirical 
fashion, if the condition is one which can be effectually and permanently 
relieved by the timely resort to surgery." 

It Is a valuable work on an important subject, well arranged, and 
printed In clear and readable type. 

NEURAL TERMS, INTERNATIONAL AND NATIONAL, by Burt G.Wilde, 
reprinted from the Journal of Comparalive Phrsiologv, Vol. vt, December, '%. 
Feb'y, '97, is a valuable and terse expost Of the author's contributions to 
Neuronomy, especially anatomlcat. These terms are coming rapidly and 
largely into use among neuro-anatomists. 

Analgesia, Thermic Anssthesia, and Ataxia, Resulting from the Foci of 
Softening in the Medulla Oblongata and Cerebellum , Due to Occlusion of the 
Left inferior Posterior Cerebellar Artery. A study of the course of the sensory 
and co-ordinating tracts in the medulla oblongata. By Henry Hun, M. D., 
Professor ol Diseases of the Nervous System in the Albany Medical College, 
Albany, N. Y. 

Syringomyelia, an essay to which was awarded the Alverenga prize of 
the College of Physicians of Philadelphia lor the year 1895. Guy Hinsdale, 
A. M.,M. D. , Fellow of the College of Physicians of Philadelphia, etc., etc., 
P. Blackiston Son & Co., Publishers. 

The Use ol Antitoxic Serum In the Treatment of Diphtheria Under the 
Supervision of the New York City Health Department with a R«sum£ of the 
Published Reports on the Subject. By Hermann M. Biggs, M. D., and 
Arthur R, Guerard, M. D., New York City. 

A Sketch of (he Gradual Perfecting of the Methods of Medical Education 



jdbyGoOglC 



Reviews, Book Notices, Etc. 461 

In the Albany Medical Colkge, By Henry Hun, M.D. The Introductory 
Lecture Delivered at the Opening of the SUty-Slxth Session of the Albany 
Medical Colleee. on Sept. 29, 1896, 

The Medko-Leea! Bearings of the Commitment of the insane, and the 
Proposed Amendments to our Law. By W. F. Becker, M. D.. Chairman 
Joint Committees State Medical and Milwaukee Bar Association on Revision 
^ of insanity Law, Milwaulcee, Wis. 

The Bacillus Proteus Zenkeri in an Ovarian Abscess. By Hunter Robb, 
M. D., Professor of Gynecology, Western Reserve University, Cleveland, 
O., and Albert A. Ghiiskey, M. O., Fonner Assistant Gynecologist to the 
Johns Hopkins Hospital. 

The Importance of a Systematic Microscopical Examination of Uterine 
Scrapings and of Excised Pieces as an Aid to Diagnosis. By Hunler Robb. 
M. D., Professor of Gynxcoiogy, Western Reserve University, Cleveland, 
Ohio. 

The Eye in Hereditary Ataxia with a Report of Four Cases of Friedreich's 
Ataxia In One Family. By Charles W. Burr, M. D., Clinical Professor of 
Nervous Diseases in the Medtco-Chirurgical College, etc. , Philadelphia. 

The Use of Nosophen and Antinosine in Surgery. By Claude A. Dun- 
dore, M. D., Philadelphia, Formerly First Assistant Surgeon, State Hospital 
tor Injured Persons of the Anthracite Coal Regions of Pennsylvania. 

Transactions of the Nineteenth Annual Meeting of the American Micro- 
scopical Society, held at Pittsburgh, Pa., August ISth, ]9Ch and 20th, 1S96. 

Cancer ot the Rectum. By James P. Tuttle, M. D., New York. 

The Correlated Professions. The Doctorate Address of the Medical 
Department o( the University of Louisville, Session of 1896-97, ByJ. M. 
Bodine, M. D., Dean, Professor of Anatomy in the University. 

Should the State Take Action to Regulate the Administration of Anaes- 
thetics? By H. J. Boldt, M.D., Professor of Gynecology in the New York 
Post-Graduale Medical School and Hospital, etc.. New York. 

Encephalitic and Late Epilepsy. By Jas. G. Klernan, M. D. Foreign 
Associate Member French Medico- Psychological Association, Professor of 
Forensic Psychiatry, Kent College ot Law, etc., Chicago, III. 

The Gold Preparations in Some Skin diseases and Syphilis. By A. H. 
Ohmann-Dumesnil, A.M.. M. D. . Prolessor of Dermatology and Syphilology 
in the Marion-Sims College of Medicine, St. Louis; etc. 

Can Society Successfully Organize to Prevent Over- Product ion of De- 
fectives and Criminals? By Barnard Douglass Eastnann, M.D., Superin- 
tendent of the Topeka State insane Asylum, etc. , etc. 

Strophanthus: A Clinical Study. By Reynold W. Wilcox, M. D.. LL. D., 
Professor of Medicine and Therapeutics at the New York PosC-Graduate 
Medical School and Hospital, etc.. New York City. 



jdbyGoOglC 



462 Reviews, Book Notices, Etc. 

The Action of Taka-DJastase in Various Gastric Disorders. By Julius 
Friedenwald, A. B., Jrt. D., Clinical Professor of Diseases of the Stomach, 
College of Physicians and SurRieons, Baltimore. 

The Relation of the Science of Medicicie to Public School Education. By 
John PunCon, M.D., Professor a( Mental and Nervous Diseases, University 
Medical College, etc., Kansas City, Mo. 

Notes on the Treatment of Fxcal FIsCulie. By Frederick Holme Wiggin. 
M. D., Visiting Gynecologist to the New York City Hospital, and Visiting 
Surgeon to St. Elizabeth's Hospital. 

Symptoms of Speech Disturbances as Aids in Ceiebral Localization. 
By }. T. Eskridge, M. D., Neurologist to the Arapahoe County and St. 
Luke's Hospitals, Denver, Col. 

Some Relations of Crime to Insanity and States of Mental Enfeeblemenl. 
By H. E. Allison, M. D., Medical Superintendent Matteawan State Hospi- 
tal. Fishklll Landing, N. Y. 

Obstetrical Paralysis of Infants. By W. H. Haynes, M. D., AssUtant 
to the Professor ol Diseases ol the Mind and Nervous System, L. 1. C. H. , 
etc., etc., Brooklyn, N. Y. 

Tumors of the Orbit. By William Cheatham, M. D., Professor of Dis- 
eases of the Eye, Ear, Nose, and Throat in the Louisville Medical College, 
Louisville, Ky. 

The Value of Apioline in Neurotic Dysmenorrhea. By D. S. Maddox, 
M. D., Marlon, O. Reprint from Tlie Medical and Surgical Rtporier. Sutie 
5th, 1897. 

Lateral Sclerosis as a Sequence of Spinal Meningitis. By Augustus A. 
Eshner, M.D, , Professor of Clinical Medicine in the Philadelphia Poly- 
clinic, Etc. 

The Causes of Hysteria. By Charles W. Burr, M. D,, Clinical Profes- 
sor of Nervous Diseases at the Medlco-Chirurglcal College, etc., Philadelphia 

Recurrent Ptosis. Report ol a Case, with Anaesthesia of Supra-orbital 
Branch of the Fifth Cranial Nerve. By W. H. Haynes, M.D., Brooklyn. 

Ectopic Gestation. By H. J. Boldt, M.D., Professor Gynecology in the 
New York Past-Graduate Medical School and Hospital, He, New York. 

Vaginal Extirpation ol the Uterus and Adnexa in Pelvic Suppuration and 
Septic Puerperal Metritis and Peritonitis. By H. J. Boldt, M.D. 

Ueber das sog. Krampfcentrum und uber das Centrum fur die Locomo- 
tion im Niveau der Varolsbrucke, Von Prof. W. V. Bechterew. 



Sanitation in Hospitals (or the Insane. By Geo, H. Rohe, M.D., 
perinlendent Second Hospital for the Insane, Sykesville, Md. 



jdbyGoOglC 



Reviews, Book Notices, Etc. 463 

A Case ol Congenital Stenosis of the Pulmonary Orilice and of the 
Conns Arteriosus. By Henry Hun, M.D., Albany, N. Y. 

Hospital Organization and Management. By Henry M. Hurd. M. D.. 
Superintendent of the Jolins Hopkins Hospital. Baltimore. 

The Paroccipital Fissure: ShoulJ it be S3 Recognized and Designated? 
By Professor B. G. Wilder, M.D.. Cornell University. 

Two Cases o( Epilepsy. By Augustus A. Eshner. M.D., Professor of 
Clinical Medicine in the Philadelphia Polyclinic, etc. 

Kemarks on liie New Law Governing Ihe Commitment of the insane. 
By W. F. Becker, M. D., Milwaukee, Wis. 



Paranoia. By Henry M. Hurd, M. D.. Professor ol Psychiatry, Johns 
Hopkins Medical School. Baltimore. 

The Relation of the Medical Profession to School Education. By Walter 
ChanninK. M. D. , Brookline, Mass. 



A Case of Profound Anaemia, Probably of Gastro-inteslinal Origin. By 
Augustus A. bshner, M.D. 



An Apparent Exception to Colles' Law, By C. Travis Drennen, M. D., 
Hot Springs. Arkansas. 

A C^se of Tactile Amnesi.i anJ Mind Blindness. By Charles W. Burr, 
.VI. D., Philadelphia. 

When to Begin the Specific Treatment of Syphilis. By Geo. M. Phillips, 
A.O., St. Louis. 

The Causes of Death after Abdominal Section. By H. J. Boldt, M. D.. 
New York City. 

TrikresoIiiHlin in Hninfiis Chronica. By Wm. B. Meaiiy. M. D.. St. 
Louis. Mo. 



Ueoer Chorea Gr.ivis. Von Prof. W. M. Bechtere*. St. Petersburg, 

A Few Notes on Squint. By Wiliiam B. Meany, M. D.. Si. Louis, Mo. 
A Case of Congenital Tremor. By Augustus A. Eshner, M.D. 
A Graphic Study of Tremor, By Augustus A. Eshner, M.D. 
Ann.^lea de L'Unisexualile. Par Andre Kaffalovkh. 



DigiLizedbyGoOglc 



,db,GoogIc 



THE 

Alienist and Neurologist. 

VOL. XVni. ST. LOUIS, OCTOBER, 1897. No. 4. 

ORIGINAL CONTRIBUTIONS. 



NEURASTHENIA ESSENTIALIS AND NEU- 
RASTHENIA SYMPTOMATICA.* 



BY F. X. DERCUM.M.D., PHILADELPHIA. 

CHnkal Profaasor tf Nervous Diseases, Jefferson Medical Collece; Neurol- 
ogist to tbc FltHadelphla HospHal. 

AT the present day there still exist, not only in the 
mind of the general practitioner, but even in the 
minds of specialists, the most vague and ill defined notions 
concerning neurasthenia. Not only do we hear from physi- 
cians of the highest standing allusions made and views ex* 
pressed in regard to neurasthenia which disclose that this all 
important affection has never received serious attention or 
study at their hands, but this is true to a very large ex- 
tent of neurologists and especially of alienists. A striking 
illustration of this proposition is furnished by the treatise 
on the pathology and therapy of neurasthenia by Binswan- 
ger which has recently made its appearance in Germany. 

•Rud bcfon Hit Nninriodul S«tlon of tha Amtricui MHIcil Assoclmlan. Philndel- 



jdbyGoOglC 



466 F. X. Dercum. 

This writer does not hesitate to say that under neuras- 
thenia we are to group all neuropathic appearances which 
rest on a basis of a eenerai functional disease of the ner- 
vous system but which cannot be placed in the same cate- 
gory with the fully developed psychoses and neuroses be- 
cause of their incomplete character. Surely, the pages .of 
medical literature have never before proposed as the defini- 
tion of a well defined and well known syndrome such as 
neurasthenia certainly is, terms more vague or more unsat- 
isfactory. It is largely because neurasthenia to the super- 
ficial observer seems uninteresting that it is so little studied 
and yet it is an affection so common, the number of cases 
so large, that we certainly owe it to ourselves to obtain 
clear, if not elementary, notions of this disease. In truth, 
neurasthenia is one of the most interesting affections which 
we can possibly study. As I will presently point out, its 
syndrome is as definite and fixed as that of any other 
disease with which we have to deal. Its boundaries 
instead of being illy defined are sharply delimited. 
The various symptom -groups occurring in neuras- 
thenia, though differing i^idely in detail, always 
present the same essential features, and, from what- 
ever standpoint they are approached, a harmonious, clini- 
cal whole, — a well proportioned and well defined syndrome, 
— is seen. The work of Binswanger illustrates in reality a 
backward step. If it is to stand, the writings of Beard, Bou- 
veret, Von HCsling and others to whose labors we owe in a 
large measure our present notions of the disease, fall to the 
ground, and all the value of the pioneer treatise of Robert 
Whyte, now over a century and a quarter old, which dif- 
ferentiates this affection clearly from the allied conditions of 
hysteria and hypochondriasis, not to speak of the writings 
of Sandras, Bouchut and others, disappears. 

Let us analyze briefly the essential features of neuras- 
thenia. In the simplest form of the affection there exists a 
more or less marked and persistent diminution of nervous 
energy and to these symptoms are added those of increased 
irritability both mental and physical. To the writer it does 
not seem that much mystery should attach to this condi- 



jdbyGoOglC 



Neurasthenia. 467 

tion, it hardly seems necessary at this day to contend that 
marked chronic fatigue should present a special syndrome, 
and yet Binswanger would have us believe that we are 
dealing with a condition which presents the most vague 
and indefinite symptomatology. These vague notions of 
neurasthenia are based first upon incomplete study and sec- 
ondly upon the apparent inability to systematically arrange 
and properly classify the facts presented. Neurasthenia is 
still in the position in which hysteria was until recent 
years in England and America, notwithstanding the 
fact that the French had demonstrated unmistakably the 
symptomatology of the latter affection. Too often neuras- 
thenia is looked upon as a vague affection made up of num- 
erous pathological factors bearing little or no relation to 
each other. The difficulty partly arises from the fact that 
the symptoms of neurasthenia are in a large measure sub- 
jective while even such symptoms as are objective lack the 
striking features observed in many other functional diseases. 
Another circumstance which has been most prolific of mis- 
conception regarding the nature of neurasthenia is the' fact 
that physicians have loosely described as neurasthenia 
symptoms which properly belong to other diseases. Thus 
the nervous symptoms associated with anaemia, chlorosis 
and other diseases of the blood, the nervous symptoms 
associated with the diseases of the pelvic organs or with 
chronic disease of the stomach have been loosely termed 
neurasthenia. If the nervous symptoms associated with 
general somatic or organic visceral diseases are to be 
termed nenrasthenic, we should be careful to bear in mind 
that they represent something very different from true neu- 
rasthenia. 1 have myself proposed for this spurious neuras- 
thenia the term neurasthenia symptomatica. If the fact 
that there exists a true neurasthenia separate and apart 
from symptomatic neurasthenia, is once firmly fixed in our 
minds, much of the confusion clinging to the subject passes 
away. 

The next fact of importance to recognize is that in true 
neurasthenia, or as I prefer to term it, neurasthenia sim- 
plex or essentiaiis, in addition to symptoms primarily indic- 



jdbyGoOglC 



468 F. X. Dercum, 

ative of the disease, others make their appearance which 
are secondary in character and importance. Frequently 
these secondary or subsidiary symptoms are superficially 
evident or unusually prominent and thus their importance is 
mistal<en and over-rated. Charcot aiso recognized these 
differences in the symptoms of neurasthenia, for he sep- 
arated the symptoms into, first, cardinal symptoms or neuras- 
thenic stigmata and, secondly, secondary or accessory symp- 
toms. In Charcot's group the fundamental symptoms or 
stigmata are the following: First, neurasthenic headache; 
secondly, sleep disturbances; third, rachialgia and spinal 
hyperasthesia ; fourth, muscular weakness; fifth, the dis- 
turbances of digestion (nervous dyspepsia); sixth, sexual 
disturbances, and seventh, mental symptoms. To these 
Charcot added the secondary or accessory symptoms which 
group consists of all symptoms which are not essential to 
the diagnosis of neurasthenia. Among them he placed such 
symptoms as giddiness, disturbances of the special senses, 
respiratory, circulatory and secretory, disturbances, disturb- 
ance's of general sensation, disturbances of motility and 
febrile conditions. 

Charcot in his classification of the symptoms of neu- 
rasthenia merely grouped together as the stigmata or fund- 
amental symptoms the most prominent clinical features of the 
disease. We will find by analysis that these symptoms are 
not by any means of equal value. Similarly the secondary 
symptoms of Charcot, which we have just enumerated, are 
of very unequal value. 

If we grasp the conception of neurasthenia, that it is in 
reality a fatigue neurosis, the symptoms group theitrselves 
very readily in a logical and orderly sequence. Primary or 
fundamental symptoms then stand out boldly and with defr- 
nite relations to each other. They are always symptoms 
which present the essential characteristics of weakness, and 
irritability and Which are always expressive of fatigue. The 
secondary symptoms are all such symptoms as are adven^ 
titious or mere secondary outgrowths of the primary or 
fundamental symptoms. I can make my meaning clear by 
enumerating some of the various primary symptoms and 



jdbyGoOglC 



Neurasthenia. 469 

contrasting them with some of the secondary symptoms. 
Beginning with the sensory disturtmnces, we have, first, a 
general sense of fatigue or tire. This sensation may be 
diffused throughout the entire body, but it is generally ac- 
centuated in special regions or limbs. It is characteristic of 
this sense of fatigue, whether it be referred to the head, to 
the back or to the limbs, that it is, in the simple and 
typical cases at least, always relieved or lessened by rest 
and further it is always brought on, if absent, or made 
worse, if present, by exertion. This readiness of fatigue, this 
general sense of tire, I regard as the primary symptoms, if in- ' 
deed not the most fundamental of all the symptoms, of neuras- 
thenia. Fatigue sensations when they become exaggerated 
become painful and they are then described by the patient 
as aches of various kinds. It frequently is a headache, 
almost as frequently a backache or the ache may be 
referred to a leg or to an arm. In the latter instance a 
few questions with reference to the avocation will almost 
always reveal the reason for the accentuation of the pain 
in one extremity. Thus, in a collector, the fatigue sensa- 
tions were most pronounced in the legs, 'in a physician who 
used his right hand constantly and for many hours daily in 
laryngeal manipulations, the fatigue sensation was accen- 
tuated in the right arm. 

These fatigue sensations, these aches of various kinds, 
let it be repeated again, are primary symptoms. Not in- 
frequently, however, we have associated with these symp- 
toms others which are secondary and which 1 have in some 
of my writings termed adventitious. Thus the headache of 
neurasthenia may be accompanied by a sense of pressure or 
constriction or by a sense of fullness, lightness or disten- 
tion. These sensations depending as they probably do 
upon disturbances of the circulation are secondary and ad- 
ventitious. They are not necessary parts of the neuras- 
thenic headache and may or may not be. present. Some- 
times other sensations are noted, such as throbbing, sense 
of increased weight, whiriing sensations, or vague and ill 
defined feelings of distress ; all of these are secondary 
in value. 



jdbyGoOglC 



470 F. X. Dercum. 

As regards backache, the simple feeling of fatigue 
referred to the lumbar region, may be complicated by hy- 
perasthesia, especially over the spinal gutter where it may 
be distributed, as is well known, in patches; I refer to so- 
called spinal hyperasthesia or spinal tenderness. This spinal 
tenderness, I regard as a secondary symptom — as one the 
indirect outgrowth of a normal fatigue sensation. It is a path- 
ological exaggeration or intensification of the fatigue sensation. 
The hyperasthesia, the sense of burning and the deep-seated 
boring pains, sometimes complained of, are clearly adventt- 
' tious and not primary. The achings referred to the legs or 
to the arms, present a similar illustration. It is very fre- 
quent to find that in addition to or in place of aching in 
the limbs the patient complains of throbbing or thrilling 
or tremulous feelings in the limbs. These sensations are 
likewise to be regarded as secondary. They are not nec- 
essarily present and are clearly adventitious. Likewise, is 
it with the various curious paraesthesiae of which neuras- 
thenics every now and then complain, such as pins and 
needle feelings, numbness, prickling or of velvety sensations, 
all of which belong to the group of secondary symptoms. 

If we pause to analyze the various visual disturbances 
of neurasthenia we find that the same trutli is evident. 
Here the principal symptoms are those expressive of 
ready fatigue. I will not pause to analyze them in detail, 
but simply to allude briefly to a few of them. One of 
the most common statements w